Effective communication among physicians during the hospital discharge process is critical to patient care. The quality of discharge documentation of patients discharged to rehabilitation centers and other subacute facilities has been less well studied than that of patients discharged home. The aim of this study was to evaluate the quality of information transfer among patients discharged from acute hospitals to subacute facilities across an integrated health care delivery system.
Discharge documentation packets of randomly sampled patients discharged from all 5 acute care hospitals of the Partners Healthcare System to subacute facilities were evaluated. Reviewers were a mix of trained medical residents at acute sites and admitting physicians at receiving subacute sites. The outcome was the presence of specific data elements required to safely care for patients after discharge (Table 1). We also calculated the “defect‐free” rate, that is, patients whose documentation contained all data elements required by the Joint Commission on Accreditation of Healthcare Organizations. Results were calculated as proportions and 95% confidence intervals
Fifteen hundred and one discharge documentation packets from March 2005 through June 2007 were reviewed. Only 1055 (70.3%) had all the information required by the Joint Commission, with physical examination at admission and condition at discharge most often missing. Other deficiencies included a list of preadmission medications and reasons for changes in these medications at discharge, pending test results, and postdischarge management and follow‐up plans (Table 1). The Joint Commission defect‐free rate varied by site, with a range of 61% to 76% across the 5 acute care hospitals
We found room for improvement in the inclusion of data elements required for the safe transfer of patients from acute hospitals to subacute facilities, especially in areas such as medication reconciliation, pending test results, and adequate follow‐up plans. We also found variation by site. For patients discharged to rehabilitation and other subacute facilities, greater efforts are needed to communicate the clinically relevant information to those providing continuing care.
E. Gandara, none; T. Moniz, none; J. Ungar, none; J. Lee, none; M. Chan Macrae, none; J. Schnipper, none.