Background: There are over 35 million discharges from inpatient hospitalizations annually in the US. During these transitions of care, patients are at risk for adverse events. It is crucial for patient safety to have accurate communication between the inpatient physician and the provider assuming care.The main conduit for this communication is the hospital discharge summary. [...]

Background: Black patients have distinct disadvantages that are associated with poor functional outcomes. Physical therapy (PT) is an invaluable tool for improving functional outcomes including hospital-associated disability and physical deconditioning. However, Black patients on trauma surgery services or with traumatic brain injury are less likely to be offered post-acute rehabilitation. Older White patients have higher [...]

Background: Inter-hospital transfer (IHT) care is complex and suffers from inefficiencies in information and task organization, which can contribute to high cognitive load for clinicians.[1-4] Cognitive overload can lead to medical errors and clinician stress.[5-8] Our study identifies specific areas of high cognitive load experienced by hospital medicine physicians and advanced practice providers (APPs) who [...]

Background: Patients’ confidence managing their health after discharge is essential to effective transitions of care. After Visit Summaries (AVSs) are a standard way of communicating discharge instructions. Past studies proposed solutions to improve discharge instructions and information retention, including simplified information pages, structured discharge letters, and graphic-based discharge information (DeSai et al., Lin et al., [...]

Background: Post-discharge phone calls to hospitalized patients have been associated with reduced 30-day readmissions.[1,2] But their impact during the COVID-19 pandemic is unknown. Further, whether the 30-day readmission metric is an accurate surrogate for care utilization remains a concern.[3-5] Since 2012, national all-cause readmissions have decreased while emergency department (ED) visits and observation status have [...]

Background: Interhospital transfer (IHT) is a pathway by which many patients may receive procedures or specialty care not available at their local hospital. While IHTs present the opportunity for resource sharing between hospitals for the purpose of improved patient outcomes, the discontinuity of care and the acuity of the patients may adversely affect other quality [...]

Background: Medication errors during hospital discharge can lead to adverse outcomes, medication-related readmissions, and increased healthcare costs [1,2]. Pharmacist-led medication reconciliation at discharge (PMRD) has emerged as a potential solution to mitigate poor outcomes and optimize medication safety [3-7]. The main objectives of this study were to determine the number of errors identified at discharge [...]

Background: Millions of patients are discharged to skilled nursing facilities (SNFs) each year. In teaching hospitals, resident physicians are often responsible for organizing this transition. Understanding residents’ knowledge and experiences of this care transition has the potential to inform residency training, education, and clinical experience. This study aimed to explore residents’ attitudes and experiences in [...]

Background: The Discharge Summary (DS) plays a vital role in transmitting key information about a patient’s hospital admission to their primary care clinician (PCC) and serves as a valuable information source for inpatient clinicians. However, current guidelines for DS creation tend to neglect the importance of prioritizing critical content. This oversight, coupled with the excessive [...]

Background: Adverse events (AEs) occur in 19-28% of hospitalized patients in the 30 days after discharge [1,2]. Though new or worsening symptoms (NWS) reported by patients are often an early indicator of post-discharge AEs, they are not systematically captured in electronic health record (EHR) documentation or via patient portals. Higher fidelity capture of patient-reported NWS [...]