Is the Discharge Information Received by PCP from Hospitals Adequate to Ensure the Continuity of Patients Care? Research Project By Suzette Bartosh, Deepa Khadka, Uchechi Okani, Abena Sarhene and Sukhraj Sohal Date: 07/27/2011 o
Agenda Adverse affects of inadequate discharge information Introduction: 1 Transition Period 2 3 4 5 Complexity of assessing the hospitalization information Communication between the hospital and PCP Effectiveness Adequacy of information 6 Accuracy of information 7 The timeliness
Literature Review The hypothesis: Patients hospital discharge information received by primary care providers is inadequate to ensure continuity of patient care.
Literature Review THE YARDSTICK The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) standards for discharge summary: Six important components: 1. Reason for hospitalization 2. Significant findings 3. Procedures and treatments provided 4. Patient s discharge condition 5. Patient and family instructions (as appropriate) 6. Attending physician s signature (Kind & Smith, n.d.)
Literature Review (Karaksha, Hattingh, & Hall, 2010) Study to determine the quality of information contained in the discharge summaries from a regional hospital to local primary care providers shows: Lack of information on patients adverse drug reactions. Low level of PCP satisfaction except for those with electronic medical records (EMR) access to hospital records. Many practices do not have EMR access
Lit Review Cont. Systematic literature review (Kripalani et al., 2007). Study to characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process. Result: Infrequent direct communication between primary care physicians and the hospital-based physicians. Majority of discharge information were electronically transferred Yet summaries lacked many important information: e.g. Counseling provided for patients and family Pending lab tests at time of discharge.
Lit Review Cont. McMillan, Allan, & Black, 2006 Purpose: To determine the accuracy of the information contained in patients hospital discharge summaries. Method: Medications listed in patients charts on admission were compared to the medication lists contained in their discharge summaries. Result: Many minor errors. Fewer major errors with the potential to cause hospital readmission. Recommendations: Summaries should clearly identify: Current medications Discontinued medications while in hospital Reasons for discontinuation of medication.
Literature Review contd. A randomized controlled trial (Preen et al., 2005). Purpose: To investigate the effects of discharge planning on patients quality of life and satisfaction of outpatient primary providers. Method: Patients from 2 hospitals were randomly assigned to two groups. Intervention group: Discharge planning per chosen intervention guideline with early communication of plan with primary care providers. Control group: Discharge according to existing protocol. Result: Improved satisfaction and quality of life for patients in the intervention group. No difference in length of hospital stay Primary care providers for patients in the intervention group showed higher level of satisfaction.
Methodology Study Design. Population and Sample. Data Collection. - To ensure the adequate continuity of care of Patients - Focus on discharge summary reports on DFW outpatients PCP - Measurement based on patient care continuity, capacity, availability and ability of communication between the Hospital and PCP.
Survey Results Content How Often the following information is recorded on discharge summary records? 80% 70% 60% 50% 40% 30% 20% 10% Never Rarely Sometimes Usually Always 0% Admission Reason Present Illness Phyiscal Examination Medical History Hospital Course
Survey Results Content Cont How often the following information is recorded on discharge summary report? 80% 70% 60% 50% 40% 30% 20% 10% Never Rarely Sometimes Usually Always 0% Discharge Diagnosis Discharge Condition Major procedures performed Physician Contact Info Meds (pre and discharge)
Survey Results Content Cont How often the following information is recorded on discharge summary report? 70% 60% 50% 40% 30% 20% 10% Never Rarely Sometimes Usually Always 0% Allergies/Drug Reaction Follow-up plans Significant Test results Pending Test Results Issues require close monitoring
Survey Results Timeliness How often do you receive the discharge information from the hospital? 70% 60% 50% 40% 30% 20% 10% Never Rarely Sometimes Usually Always 100% would like a discharge summary after their pts release from the hospital! 0% Discharge information received
Survey Results Dependent How Dependent are you? 70% 60% 50% 40% 30% 20% 10% 0% How Dependent are you? Dependent on the Discharge summary report Not Dependent Little Dependent Never Dependent Fairly Dependent Always Dependent
Survey Results Satisfaction How Satisfied are you? 70% 60% 50% 40% 30% Not Satisfied Little Satisfied Never Satisfied Fairly Satisfied Always Satisfied 20% 10% 0% Satisfied with Discharge summary report
Conclusion Majority of PCPs are fairly satisfied with the timeliness and content of the discharge information However study showed deficiencies in medical history, pending test results, and issues requiring close monitoring The least reported information on the discharge summary was patient s pending test results. Majority of PCP are dependent on the hospital discharge summaries from to provide continuity of patient care.
Limitations Small number of participants. No consideration for the size of the clinics (staff & patient population) No survey of the degree of technological advancement for each facility. No consideration to the location, whether urban or suburban.
References Karaksha, A. A., Hattingh, H.L., & Hall, T. (2010). Quality of Discharge Summaries sent by a Regional Hospital to General Practitioners.Journal of Pharmacy Practice and Research, 40(3), 208-210. Retrieved from http://www98.griffith.edu.au/dspace/bitstream/10072/34849/1/65249_1.pdf Kind, A. J.H., & Smith, M. A. (n.d.).documentation of Mandated Discharge Summary Components in Transitions from Acute to Subacute Care. Retrieved from July 18, 2011, from http://www.ahrq.gov/downloads/pub/advances2/vol2/advances-kind_31.pdf Kripalani, S.,LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., and Baker, D. W. (2007). Deficits in Communication and Information Transfer Between Hospital- Based and Primary Care Physicians Implications for Patient Safety and Continuity of Care.JAMA. 297(8):831-841. Retrieved from http://jama.ama-assn.org/content/297/8/831.full.pdf Preen, D. B., Bailey, B. S., Wright, A., Kendall, P., Phillips, M., Hung, J.,Hendriks, R., Mather, A., & Williams, E. (2005). Effects of a multidisciplinary, post-discharge continuance of care intervention on quality of life, discharge satisfaction, and hospital length of stay: a randomized controlled trial. International Journal for Quality in Health Care,17(1), 43 51. Retrieved from http://intqhc.oxfordjournals.org/content/17/1/43.full.pdf
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