Patient Discharge Summaries Research Articles

An audit of medicines information quality in electronically generated discharge summaries – evidence to meet the Australian National Safety and Quality Health Service Standards

AbstractBackgroundProblems with achieving the continuum of medicines management are long‐standing. Audits are valuable in improving medication management and the quality and safety of healthcare systems.AimTo evaluate the accuracy and timeliness of electronic discharge summaries (EDS) provided to patients and their primary care providers at discharge. This was a forerunner to the study hospital's National Accreditation Examination and for routine safety and quality evaluation.MethodsThis study was a retrospective audit using an adaptation of the NSW indicator 5.3, ‘Percentage of discharge summaries that include medication therapy changes and explanations for changes’ (National quality use of medicines indicators for Australian Hospitals. ACSQHC, Sydney, NSW, 2014). The additions to the NSW tool included: assessing the completion and timeliness of delivery to primary health care providers, and the accuracy of the information.ResultsIn patients leaving hospital, 75% had a hospital EDS completed, with 46% completed within the recommended 48 h from discharge. For an EDS to be delivered, a primary healthcare provider must be nominated by the patient. This occurred in 53% of our sample. Accuracy of information on what medicines patients should use post‐discharge was also assessed. It indicated 46% accuracy, with the majority of errors being omissions of required medicines. None of the EDSs included documented reasons for changes to medicines, in the provided table, to the primary healthcare provider. In patients on a short‐term therapy, such as antibiotics, 71% of EDSs had documented a plan for short‐term therapies to be completed in the community.ConclusionThe lack of information on the primary care provider recorded in the patient's clinical system and discharge summaries, limited the timely transfer of essential information on post‐discharge medicine management to the patient's primary care provider. Work has commenced on an educational program to improve data entry of the patient's primary care provider when they are admitted, and plans to improve compliance with the EDS policy.

Evaluating insulin information provided on discharge summaries in a secondary care hospital in the United Kingdom

BackgroundPrescribing errors at the time of hospital discharge are common and could potentially lead to avoidable patient harm, especially when they involve insulin, a high-risk medicine widely used for the treatment of diabetes mellitus. When information regarding insulin therapy is not sufficiently communicated to a patient’s primary care provider, continuity of care for patients with diabetes may be compromised. The objectives of this study were to investigate the nature and prevalence of insulin-related medication discrepancies contained in hospital discharge summaries for patients with diabetes. A further objective was to examine the timeliness and completeness of relevant information regarding insulin therapy provided on discharge summaries.MethodsThe study was undertaken at a large foundation trust hospital in the North of England, UK. A retrospective analysis of discharge summaries of all patients who were being treated with insulin and were included in the 2016 National Inpatient Diabetes Audit was conducted. Insulin regimen information provided on discharge summaries was scrutinised in light of available medical records pertaining to the admission and current national recommendations.ResultsThirty-three (79%) out of the 42 patients included in the study had changes made to their insulin regimen during hospital admission. Eighteen (43%) patients were identified as having an error or discrepancy relating to insulin on their discharge summary. A total of 27 insulin errors or discrepancies were identified on discharge, most commonly involving non-communication of an insulin dose change (n = 8) and wrong insulin device (n = 7). Seventeen issues relating to completeness of insulin information were identified, including the omission of the prescribed time of insulin administration (n = 10) and unexplained insulin dose change (n = 4). Two patients who had insulin-related errors identified on their discharge summaries were readmitted to hospital within 30 days of discharge due to poor diabetic control.ConclusionsThis small-scale study demonstrates that errors and discrepancies regarding insulin therapy on discharge persist despite current insulin safety initiatives. Poorly communicated information regarding insulin therapy may jeopardise optimal glycaemic control and continuity of patient care. Insulin-related information should be comprehensively documented at the point of discharge. This is to improve communication across the interface and to minimise risks to patient safety.

Quality assessment of discharge summaries from an emergency department in eastern Nepal

Background: Discharge summaries are intended to transfer important clinical information from inpatient to outpatient settings and between hospital admissions. A good discharge summary helps physician to provide continuity of care which will in turn improve patient outcomes. Despite the importance of the discharge summary, there has been relatively little research in this area in Nepal. We therefore decided to review discharge summaries of patients discharged from emergency department in eastern Nepal.Objective: To assess the completeness of discharge summaries from emergency department. Methods: A total of 360 discharge summaries, representing 20% of discharge from the emergency department of B.P. Koirala Institute of Health Sciences, Nepal were randomly selected and evaluated. Quality of discharge for completeness was evaluated using recommendations by Joint Commission on Accreditation of Hospital for the presence or absence of the following key items: admission diagnosis, drug allergy, physical examination, significant laboratory test and results, discharge diagnosis, procedures, discharge medication (including dose and duration), follow up and attending physician signature.Results: The proportion of discharge summaries missing particular component of vital data ranged from less than 4% (no discharge medications) to 97% (no mention of drug allergy). Information was missing on patients discharge condition (74%), hospital course (61%), discharge instruction (57%) and the discharge diagnosis in (13%). Most of the discharge summaries were partially structured representing 75%. Ease of access to the diagnosis was 78%.Conclusions: Though most of the discharge summaries were structured and access to the diagnosis was 78%, considerable deficiencies in the completeness of discharge summaries were found. Health Renaissance 2015;13 (3): 41-47

The automated patient discharge summary: improving communication at transfers of care after completion of radiotherapy

AbstractAimTo develop an auto-generated patient discharge summary for all patients being treated in the Radiation Therapy Department.Materials and methodsA patient discharge summary was developed using auto-generated data for all patients being treated in the Radiation Therapy Department. This ensures information relevant to the care of the patient is communicated effectively during transitions of care following radiation treatment, and provides a record of the treatment site(s), dose delivered, start/completion dates and contact information for Radiation Oncologists. The eScribe feature in MosaiQTM is utilised to auto-generate the patient discharge summary in less than one minute, and then printed and given to patients on the last day of treatment. This was piloted with palliative radiotherapy patients (n=22), who also completed a telephone survey.ResultsResults revealed patients had passed this document onto other healthcare providers and appreciated having a record of their treatments. Feedback was obtained from radiation therapy staff and the Patient and Family Advisory Committee. Subsequently, the language of the patient discharge summary was simplified and a disclaimer was added, indicating the document is not a complete radiation therapy treatment record. This initiative was then rolled out to all radiotherapy patients.FindingsOverall, the patient discharge summary allows for a quick, automated and standardised approach for transfer of information during care transitions without significant impact to the Radiation Therapy Departmental workflow.

Novel combined patient instruction and discharge summary tool improves timeliness of documentation and outpatient provider satisfaction.

Background:Incomplete or delayed access to discharge information by outpatient providers and patients contributes to discontinuity of care and poor outcomes.Objective:To evaluate the effect of a new electronic discharge summary tool on the timeliness of documentation and communication with outpatient providers.Methods:In June 2012, we implemented an electronic discharge summary tool at our 145-bed university-affiliated Veterans Affairs hospital. The tool facilitates completion of a comprehensive discharge summary note that is available for patients and outpatient medical providers at the time of hospital discharge. Discharge summary note availability, outpatient provider satisfaction, and time between the decision to discharge a patient and discharge note completion were all evaluated before and after implementation of the tool.Results:The percentage of discharge summary notes completed by the time of first post-discharge clinical contact improved from 43% in February 2012 to 100% in September 2012 and was maintained at 100% in 2014. A survey of 22 outpatient providers showed that 90% preferred the new summary and 86% found it comprehensive. Despite increasing required documentation, the time required to discharge a patient, from physician decision to discharge note completion, improved from 5.6 h in 2010 to 4.1 h in 2012 (p = 0.04), and to 2.8 h in 2015 (p < 0.001).Conclusion:The implementation of a novel discharge summary tool improved the timeliness and comprehensiveness of discharge information as needed for the delivery of appropriate, high-quality follow-up care, without adversely affecting the efficiency of the discharge process.

Patient Characteristics Associated with Inpatient Psychiatric Re-admissions and the Utility of the READMIT Clinical Risk Index

ABSTRACTIn response to the problem of frequent 30-day readmissions to inpatient psychiatric facilities, Vigod and colleagues (2015) developed the READMIT clinical risk index to identify risk factors for psychiatric inpatient readmissions. The purpose of this descriptive retrospective study was to examine the effectiveness of the READMIT clinical risk index to identify patients that are at high risk for a 30-day inpatient psychiatric readmission at a state psychiatric hospital in the southeastern US. Data were extracted from the discharge summaries of patients discharged between September 2013 and December 2014. Data collected included patient demographic variables (age, gender, race/ethnicity, primary diagnosis, housing status at discharge, employment, long-acting injectable at discharge, substance abuse, education, and insurance status) and study variables from the READMIT clinical risk index (repeat admission, emergent admission, age, diagnosis and discharge, medical comorbidity, intensity, and time in hospital). The inclusion criterion was age 18 and above. There were no exclusion criteria. Findings indicated that age, insurance status, previous lifetime admissions, ‘diagnoses and discharge’ scores, and higher READMIT clinical risk index scores were associated with 30-day readmissions. Future research should include a prospective study of the READMIT clinical risk index to assess its predictability of 30-day readmissions and explore possible use of the minimum clinical risk index score to trigger evaluation of patient need for enhanced transitional careservices posthospital discharge.

Magnitude of Postpartum Hemorrhage among Women Delivered at Dessie Referral Hospital, South Woll, Amhara Region, Ethiopia

Background: Postpartum hemorrhage refers loss of more than 500 and/or 1000 ml of blood within 24 hour following vaginal, caesarean delivery respectively. It is significant public health problem both in developed and developing countries, causing considerable maternal mortality and morbidity. It is highly fatal if diagnosis and treatment is not provided early. In Ethiopia, the government launches different strategies to prevent postpartum hemorrhage. But still more than half of the maternal mortalities occurred after delivery due to hemorrhage. Even though postpartum hemorrhage is one of the major direct causes of maternal death in Ethiopia, there are only few studies done in the country. Therefore, determining magnitude and associated factors that causes postpartum hemorrhage is important to make different interventions. Objective: The aim of this study is to assess magnitude and factors associated with postpartum hemorrhage in Dessie referral hospital. Methods and materials: Institutional based cross-sectional study was conducted in Dessie referral hospital from 5th January 2017 to 10th January 2017. A one year document review (8th July 2015-7th July, 2016) was conducted. Data was collected using structured data extraction format from patient cards, admission and discharge summary registrations, operation registration log books and delivery registration log books. Descriptive statistics were done to characterize the study population using different variables. Bivariate and multiple logistic regression models were fitted to control confounding factors. Odds ratios with 95% confidence intervals were computed to identify determinants of preeclampsia. Result: In this study, the overall magnitude of postpartum hemorrhage was 5.8%. Delivering women who have not ANC follow-up were about eleven (AOR, 11.3, 95% CI, 4.2-30.2) times more risk of developing PPH than those who have ANC follow-up. Delivering women who had 24 hour and more duration of labor were eight (3.0, 23.0) (AOR, 8.3, 95% CI, 3.0-23.0) times more risk of PPH development as compared to these who had less than 24 hour duration of labor. Conclusion and Recommendation: The overall magnitude of postpartum hemorrhage is low in this study when compared with previous studies. But still it needs the attention of the government to reduce maternal and child mortality and morbidity. Non utilization of ANC, cesarean section, prolonged duration of labor and multiparty are predictors of postpartum hemorrhage. Health care providers should give high attention to initiate ANC, women who give birth by cesarean section.

Natural language processing to extract symptoms of severe mental illness from clinical text: the Clinical Record Interactive Search Comprehensive Data Extraction (CRIS-CODE) project

ObjectivesWe sought to use natural language processing to develop a suite of language models to capture key symptoms of severe mental illness (SMI) from clinical text, to facilitate the secondary...

Using the Behaviour Change Wheel to identify interventions to facilitate the transfer of information on medication changes on electronic discharge summaries.

There is evidence that the transfer of information on medication changes on patient discharge summaries is poor. By considering the completion of an electronic discharge summary as a behavior, the various components of the behavior can be targeted to improve their completion so that they consistently include information on medication changes. Study objectives were to identify the barriers and facilitators to junior doctors completing information on medication changes on electronic discharge summaries, including why these occurred. In this qualitative study, 12 semi-structured interviews were conducted with junior doctors. An interview topic guide based around the COM-B model (Capability, Opportunity, Motivation, Behavior) within the Behavior Change Wheel (BCW) was used. Transcripts of the interviews were analyzed using framework analysis to identify key categories emerging from the data. Barriers and facilitators to completing information on medication changes on discharge summaries were identified. These were then mapped to behavioral components within the COM-B model to help design tailored interventions to affect change. Nine categories were identified that encompassed the identified barriers and facilitators. The identified barriers and facilitators influenced all aspects of the COM-B model. Use of the BCW as a theoretical lens for this study enabled interventions to be identified that targeted specific components of behavior. It is the implementation of all these interventions that may be required to influence behavior change and ensure all electronic discharge summaries contain information on medication changes. All intervention functions were relevant but key functions were education, enablement and persuasion. Other institutions can use the BCW and the COM-B model to develop their own tailored interventions to achieve these functions.

Auditing of discharge summaries Contet at Al Amal medical complex

Introduction and aimsPatient's records are the most important clinical assets and tools which are required in consultations. Patient records also support the accurate continuity of care when patients return to other health providers.ObjectiveUnderstand the extent of Discharge Summaries, which conform to the set best practise guidelines on the Mental Health Service.MethodA cross-section retrospective study on Discharge Summary contents was conducted at Al Amal Medical Complex. Chart review of randomly selected patient files (200 of a total 495), of Discharge Summaries for Psychiatric Patients in 2014 was performed. The data was statistically analysed using descriptive statistics taking into account proportions and frequencies. Pearson chi square and Fisher's test methodologies were used.ResultThis study found of the 200 randomly selected Discharge Summaries that documented data of mental health examination 94% (n = 188), data of discharge date 100% (n = 200) while data of social investigation and family work up 82% (n = 164). The above three categories were the only categories to conform to standard discharge guidelines. The other thirteen items studies were found not conforming to the defined standard guidelines.Conclusion and recommendationThere is an active challenge for clinicians to introduce good clinical practice in Mental Health. Standard guidelines must be followed by clinician's in order to reduce potential areas of concern and achieve a good clinical practise. Regular recurring audits are highly needed&amp; recommended to ensure the alignment with standard guidelines for the writing of Discharge Summaries.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

The Auto-generated Patient Discharge Summary: A Single Centre Pilot Project for Standardization of Information during Care Transitions

ments at the end. In order to maximize patient engagement, the prototype was also reviewed with a patient group to help evaluate its content and to validate the design process. A final element of the project involves the creation of a provincial database for result storage, access, and future analysis. Results/Benefits/Challenges: Establishing a standardized satisfaction survey has great benefit to enhance patient engagement whereby patients have the opportunity to shape the future radiation therapy experience. The main challenge of this initiative is the stakeholders consultation because it involves processes both internal and external to the agency. Moreover, the survey prototype needs to report outcomes that align with the performance indicator as required by the BC Ministry of Health. Conclusion/Impact/Outcomes: The new, simplified and standardized survey will not only be a vital component in the evaluation of radiation therapy services, but can also improve survey collection rates and identify any potential gaps in the care delivery. Furthermore, qualitative information collected from the standardized survey will be used as a part of the quality improvement indicators to continuously enhance the BCCA’s radiation therapy services.

Compliance with the Health Information and Quality Authority of Ireland National Standard for Patient Discharge Summary Information: a retrospective study in secondary care.

Unexplained changes to medication are common at hospital discharge and underscore the need to standardise patient discharge clinical documentation. In 2013, the Health Information and Quality Authority in Ireland published a Standard on the structure and content of discharge summaries. The intention was to ensure that all necessary information was complete and communicated to the next care provider. This study investigated one Hospital's compliance with the Standard, and appraised two methods of electronic discharge communication (Symphony or Tallaght Education and Audit Management System (TEAMS)). A retrospective survey of 198 randomly selected discharge summaries was conducted at the study hospital, a 600 bed academic teaching hospital located in Dublin, Ireland. Of the 198 evaluated summaries, mean total compliance was 77%±4.2 (95% CI 76.3 to 77.5). Most (84.7%, n=173) summaries were completed using one of the systems (TEAMS). Absence of communication about alteration of preadmission medication was frequent (107 out of 130 patients (82.3%, CI 76.2 to 89.2)). Higher compliance rates were observed however, when information was interfaced or where there were dedicated fields to be completed. Efforts to improve compliance with the National Standard for Patient Discharge Summary Information should focus on reporting changes made to medication during hospitalisation.

Discharge summaries for patients undergoing acute scrotal exploration: Are we providing accurate essential information?

Objective: To investigate the accuracy of electronic discharge summaries (EDSs) written for patients who had undergone acute scrotal exploration for suspected testicular torsion. Methods: We reviewed the operation notes and EDSs for 169 admissions over a 52-month period where patients had undergone acute scrotal exploration for suspected acute testicular torsion and reviewed the correlation between what was written in these documents, focusing on laterality of pain, operative findings and procedure performed. Results: We found that the side of testicular pain was not mentioned in 14.8% of EDSs, the operative findings recorded on the EDS did not correlate to those on the operation notes in 17.2% of cases and the overall procedure performed did not correlate in 35.5% (with most of these relating to the laterality of the operation). The fact that an operative procedure happened at all was not mentioned in 4.7% ( n = 8) of the EDSs. Conclusions: The information in such an important medical document needs to be accurate, and we advocate that the person performing the operation should initiate the discharge summary process, where EDS use is the norm for discharge. Junior doctors entering urology departments must also be trained on the key information to be included in urological EDSs.

Information on functioning found in the medical records of patients with stroke.

[Purpose] To explore data on functioning in the medical records of patients with stroke by linking them to the ICF. [Subjects and Methods] The admission and discharge summaries of patients’ electronic medical records (EMRs) were investigated. Information on functioning included in the summaries were mapped into the ICF. Each of the linked categories of ICF was analyzed using frequency and percentage analysis. [Results] Thirty stroke patients’ records were evaluated. A total of 1,832 items on functioning in the EMRs were found to be linked to eighty-five categories of the ICF. The majority of those categories (52.9%) belonged to the body function domain, whereas only 8.2% were environment factors. Categories in the domain of activity and participation, and body structure were found to be 22.4% and 16.5% respectively. In each domain, the most frequently found categories were muscle power function (b730), structure of brain (s110), walking (d450), and products or substances for personal consumption (e110). [Conclusion] It was found that the admission and discharge summary in the current medical records of patients with stroke contained much noticeable information on functioning and the data on functioning may be linked to the ICF. Further study is needed to adapt ICF in Korean clinical settings.

An intervention to improve discharge summary completion rates within an Australian teaching hospital

Objective: This study was designed to improve patient discharge summary completion rates directly following patient hospital discharge. The primary reason for this was to improve continuity of patient care and reduce hospital readmissions within 28 days.Methods: The researcher benchmarked the discharge summary completion rate before conducting individual feedback directly to clinicians. Content was deemed complete if the information was present and appropriate. Partially completed, unclear, or absent information was deemed outstanding. This information was gained by looking at the hospital’s patient records. The researcher benchmarked the readmission data. This data included establishing monthly patient discharges (excluding deaths) and the number of unplanned and unexpected readmissions within 28 days related to the primary admission. This information was used to compare pre-intervention to invention readmission rates.Results: The hospital’s total discharge completion rate statistically changed from 91.92% pre-intervention to 99.18% postintervention, with the biggest change occurring in Obstetrics and Gynaecology (O&amp;G). O&amp;G discharge completion rate improved from 46.94% pre-intervention to 98.84% post-intervention. A two sample t-test indicated that this difference was significant, t(2.0905) = 0.0458, p = .05. The readmission rates statistical changed from 0.49% pre-intervention to 0.26% during the intervention period. A two sample t-test indicated that this difference was significant, t(2.3679) = 0.04205, p = .05.Conclusions: This study provided evidence of the effectiveness of conducting audit and feedback sessions as it relates to patient discharge summaries and readmissions.

Assessing Origins of Quality Gaps in Discharge Summaries: A Survey of Resident Physician Attitudes.

Because little is known about attitudes of primary authors of discharge summaries in academic institutions, namely trainees and physician assistants (PAs), we sought to explore values, possible areas for improvement, and interest in formal discharge summary education. A survey composed of Likert scale analyses, dichotomous relationships, and open-ended questions was designed using focus groups and validated via expert committee review. Of 135 total residents (PGY 1-3), 79 residents and 10 PAs in a large academic hospital in New York City completed it. Of surveyed trainees, 77.2% reported that quality discharge summaries are useful in primary care. Interns had less outpatient experience with discharge summaries compared to PGY 2&3s (23.7% vs. 63.4%, p< 0.001) and were less comfortable authoring discharge summaries for patients who were not as familiar to them (47.4% vs. 24.4%, p=0.04). The majority (54.8%) of interns as well as all PAs reported never receiving feedback on discharge summaries. Finally, 63.2% of interns and 90% of PAs responded that formal teaching would be helpful. Interns' greater discomfort may speak to their poor understanding of core components of a useful discharge summary, which teaching sessions may improve. Alternatively, shifting the authorship responsibility from interns to seniors could be explored as a quality improvement initiative.

Paracetamol overdose secondary to dental pain: a case series.

There have been documented cases of serious and life-threatening health effects due to patients taking unintentional analgesia overdose secondary to dental pain. We aimed to determine firstly what proportion of unintentional paracetamol overdose cases admitted to an acute medical assessment unit (MAU) were secondary to dental pain, secondly what proportion of such cases encountered barriers to accessing emergency dental care and finally what clinical burden such cases placed on the hospital services. The clinical coding department provided information to allow appropriate identification and data collection from patient discharge summaries and case notes of all unintentional paracetamol overdose cases secondary to dental pain over a 24 month period (1 March 2012 to 28 February 2014). One hundred and sixteen admissions were identified specifically for unintentional paracetamol overdose. Dental pain accounted for 48 (41%) of all cases. Females (67%) were twice as likely to be admitted, compared to males (33%), with a mean age of 36 years and four months. Thirty-two (63%) non-dentally registered and all nine (100%) registered patients were unable to access timely emergency dental care before their admission. Forty cases (83%) were referred to the hospital oral and maxillofacial services (OMFS). Thirty-seven (93%) patients underwent elective outpatient dental extractions and the remaining three (7%) patients were admitted for intravenous antibiotics, incision and drainage and dental extractions. All patients were treated under local anaesthetic. Dental pain is the single most common cause of acute medical admission secondary to unintentional paracetamol overdose. Patients registered with a general dental practitioner (GDP), as well as those not registered with a GDP, had difficulty accessing timely emergency primary dental care.

Summary of: Paracetamol overdose secondary to dental pain: a case series.

There have been documented cases of serious and life-threatening health effects due to patients taking unintentional analgesia overdose secondary to dental pain. We aimed to determine firstly what proportion of unintentional paracetamol overdose cases admitted to an acute medical assessment unit (MAU) were secondary to dental pain, secondly what proportion of such cases encountered barriers to accessing emergency dental care and finally what clinical burden such cases placed on the hospital services. The clinical coding department provided information to allow appropriate identification and data collection from patient discharge summaries and case notes of all unintentional paracetamol overdose cases secondary to dental pain over a 24 month period (1 March 2012 to 28 February 2014). One hundred and sixteen admissions were identified specifically for unintentional paracetamol overdose. Dental pain accounted for 48 (41%) of all cases. Females (67%) were twice as likely to be admitted, compared to males (33%), with a mean age of 36 years and four months. Thirty-two (63%) non-dentally registered and all nine (100%) registered patients were unable to access timely emergency dental care before their admission. Forty cases (83%) were referred to the hospital oral and maxillofacial services (OMFS). Thirty-seven (93%) patients underwent elective outpatient dental extractions and the remaining three (7%) patients were admitted for intravenous antibiotics, incision and drainage and dental extractions. All patients were treated under local anaesthetic. Dental pain is the single most common cause of acute medical admission secondary to unintentional paracetamol overdose. Patients registered with a general dental practitioner (GDP), as well as those not registered with a GDP, had difficulty accessing timely emergency primary dental care.

Hospital variation in quality of discharge summaries for patients hospitalized with heart failure exacerbation.

Single-site studies have demonstrated inadequate quality of discharge summaries in timeliness, transmission, and content, potentially contributing to adverse outcomes. However, degree of hospital-level variation in discharge summary quality for patients hospitalized with heart failure (HF) is uncertain. We analyzed discharge summaries of patients enrolled in the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) study. We assessed hospital-level performance on timeliness (fraction of summaries completed on the day of discharge), documented transmission to the follow-up physician, and content (presence of components suggested by the Transitions of Care Consensus Conference). We obtained 1501 discharge summaries from 1640 (91.5%) patients discharged alive from 46 hospitals. Among hospitals contributing ≥ 10 summaries, the median hospital dictated 69.2% of discharge summaries on the day of discharge (range, 0.0%-98.0%; P<0.001); documented transmission of 33.3% of summaries to the follow-up physician (range, 0.0%-75.7%; P<0.001); and included 3.6 of 7 Transitions of Care Consensus Conference elements (range, 2.9-4.5; P<0.001). Hospital course was typically included (97.2%), but summaries were less likely to include discharge condition (30.7%), discharge volume status (16.0%), or discharge weight (15.7%). No discharge summary included all 7 Transitions of Care Consensus Conference-endorsed content elements, was dictated on the day of discharge, and was sent to a follow-up physician. Even at the highest performing hospital, discharge summary quality is insufficient in terms of timeliness, transmission, and content. Improvements in all aspects of discharge summary quality are necessary to enable the discharge summary to serve as an effective transitional care tool.

Association of discharge summary quality with readmission risk for patients hospitalized with heart failure exacerbation.

Patients admitted with heart failure have disproportionately high readmission rates, most recently ranging from 17.5% to 30.3% nationally.1 The Affordable Care Act penalizes hospitals with higher than average readmission rates after admissions for heart failure. However, clinicians remain uncertain, which strategies are associated with reducing readmissions in this population.2 Experts have proposed that the creation and transmission of a high-quality discharge summary to outpatient clinicians may improve the transition from hospital to home. Discharge summaries may facilitate safer transitions in care by informing outpatient clinicians about the course of hospitalization, identifying pending studies requiring follow-up, suggesting further follow-up testing, and clarifying changes in medications and treatments after discharge. Nonetheless, despite widespread enthusiasm for improving the quality of discharge summaries, there have been few studies of the effectiveness of discharge summaries in helping to avoid readmissions, and those few have found no association of timeliness,3,4 transmission,5,6 or content5 with readmission. To determine the association of discharge quality and readmission in a large national sample, we examined discharge summaries of patients enrolled in the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) randomized controlled trial. ### Study Cohort and Setting The Tele-HF study included patients living at home and hospitalized for heart failure in the previous 30 days.7 Patients in Tele-HF were recruited from 33 cardiology practices in 21 states and the District of Columbia. We obtained discharge summaries for the index hospitalization. Wherever possible, we obtained …