Better Communication at Discharge Could Reduce Hospital Readmissions, Studies Report

Hospitals could have fewer readmissions and improve the recovery time for patients if they made sure to quickly deliver a detailed discharge summary to each patient’s doctors, according to two studies from the Yale School of Medicine recently published in Circulation: Cardiovascular Quality and Outcomes.

In a press release about the studies, lead author Dr. Leora Horwitz, MD, MHS, indicated that while a discharge summary is supposed to help doctors understand the treatment a patient received in the hospital, in practice it has functioned as an aid for medical billing.

The Yale researchers used data from “Telemonitoring to Improve Heart Failure Outcomes,” a large study of heart-failure patients. The data included more than 1,500 discharge summaries from 46 U.S. hospitals.

In the press release, Dr. Horwitz said a discharge summary needs three factors to make the transition from hospital to home safer – it has to be timely, it has to be sent to the outside physician and it has to include useful information.

“The medical community hasn’t really made full use of discharge summaries as a tool for transitions,” she said in the release.

In the first study, researchers examined data for the hospitals’ timeliness in completing the summaries, sending the summary to doctors outside the hospital and the thoroughness of the summary. A median of 69.2 percent of the hospitals in the study dictated the summaries on the day patients were discharged and documented the delivery of a third of the summaries. Fierce Healthcare reported the median provider included only 3.6 of the seven elements recommended by the Transitions of Care Consensus Conference, and none of the summaries had all of the seven recommended elements.

The press release stated that even at the best-performing hospitals, discharge summaries were “insufficient in terms of timeliness, transmission, and content. No hospital consistently produced high-quality summaries in all domains.”

The second study looked at how the discharge summaries relate to hospital readmissions, with researchers analyzing 1,246 summaries from 45 hospitals. Fierce Healthcare reported that after adjusting the data for hospital and patient characteristics, the researchers found sending discharge summaries to outpatient doctors lowered readmission rates. Summaries with more useful content, including more of the seven elements, also lowered readmissions.

“This study tells us for the first time that it is actually worth spending the time and effort to improve discharge communication, and patients do seem to benefit,” Dr. Horwitz said in the press release.

In an article in the New Haven Register, Dr. Steven Wolfson, a local cardiologist not associated with the study, said transitions between a hospital or a nursing facility to home are among the most dangerous times in a patient’s life, and information flow is critical.

“If you discharge a patient from the hospital and the physician that is now going to be following them is not given a discharge summary that is accurate and complete, then [the doctor is] going to screw things up,” Dr. Wolfson said in the article.

Medical miscommunications can have serious consequences for patients. The Seattle medical malpractice lawyers at Morrow Kidman Tinker Macey-Cushman, PLLC can help if you have reason to believe that you or a loved one was harmed by a negligent breakdown in the communication between health-care professionals, including incomplete or nonexistent discharge reports. Our attorneys have recovered millions of dollars on behalf of those injured by negligent medical care. For a free review of your case, complete our online contact form.