Study Shows Room For Improvement in Care Transitions

Discharge summary quality is “insufficient in terms of timeliness” and improvements are necessary to be an effective transitional care tool, according to a study published Jan. 13 in Circulation: Cardiovascular Quality and Outcomes.

The authors analyzed discharge summaries of 1,640 patients with heart failure from 46 hospitals enrolled in the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) study. They looked at hospital-level performance on timeliness, documented transmission to the follow-up physician, and if the seven elements recommended by the Transitions of Care Consensus Conference were included. 

Results showed that of the hospitals with 10 or more summaries, the median hospital dictated 69.2 percent of discharge summaries on the day of discharge; documented transmission of 33.3 percent of summaries to the follow-up physician, and included 3.6 of the seven Transitions of Care Consensus Conference elements. Of note, none of the discharge summaries included all three quality criteria of timeliness, transmission and content.

The authors note that “the range in hospital performance suggests that attention to transitional care processes might help produce consistently higher quality summaries.”

Moving forward, the authors add that their study “provides an impetus for improvements in discharge summary quality and guidance for intervention attempting to improve these deficiencies.”

“Recognizing that there are gaps in the transition of care, the ACC’s Hospital to Home (H2H) quality improvement program was implemented to help hospitals reduce readmissions and improve transitions of care by sharing best practices and disseminating evidence-based strategies and toolkits,” said Harlan Krumholz, MD, SM, FACC, co-author of the study. “This study provides evidence that can be directly targeted by the H2H network and all institutions interested in improving the recovery period for patients. Improving communication can improve outcomes.”

A separate study also published Jan. 13 in Circulation: Cardiovascular Quality and Outcomes reaffirms the need to improve communication and found that “high-quality discharge summaries were associated with reduced risk of readmission for patients with heart failure.”

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Attention, Communication, Follow-Up Studies, Heart Failure, Humans, Patient Discharge, Patient Readmission, Physicians, Quality Improvement

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