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Back in the Hospital - 06/08/2016

Back in the Hospital

Patient Discharge Summary Delays Can Lead to Readmissions
Release Date: June 8, 2016

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A team of Johns Hopkins clinicians and researchers today published a study linking the length of time it takes a physician to complete a patient’s discharge report with the risk of that patient’s readmission to the hospital.

"The odds of readmission for patients with delayed discharge summaries were small but significant," writes Erik H. Hoyer, M.D., deputy director for patient safety in the Johns Hopkins Hospital's Department of Physical Medicine and Rehabilitation, the lead author of the study.

Hoyer's study, published today in the Journal of Hospital Medicine, associates an increased risk of hospital readmission with a longer time between the patient’s discharge and the completion of the physician’s discharge report.

Hospital discharge summaries, which include things like why the patient was hospitalized, key findings, responses to therapy and what medications the patient is taking, can provide valuable information to future health care providers about the specifics of a patient’s condition.

Hoyer studied nearly 88,000 consecutive discharges at The Johns Hopkins Hospital between 2013 and 2014. Of those discharged patients, 16 percent were readmitted to the hospital, nearly half of whom were readmitted before their summaries were completed.

The study's median to complete the discharge summary was eight days. Providers who took longer than three days to complete the discharge report were significantly more likely to have patients readmitted. The study also found that, with every additional three days it took to complete the discharge summary, the chances of readmission increased.

"Having a timely discharge summary may not always prevent readmissions," says Hoyer, "but our study showed that 43 percent of readmission occurred before the discharge summary completion."

Hoyer also wrote that a delay in completion of the discharge summary could be a marker for poor transitions of care, since important medical information is not shared from care team to care team.

"Because readmissions often occur soon after discharge, having timely discharge summaries may be particularly important to outcomes," writes Hoyer.

Generally, the longer the hospital stay, the longer it took physicians to complete the discharge summary. Delays in discharge summary completion, writes Hoyer, could be attributable to stressed work environments for providers, as well as flaws in communication culture. Discharge summaries could also be delayed because the patient has already been readmitted, making the original summary less relevant, says Hoyer.

The research began as part of a Center of Medicare and Medicaid Innovation grant to explore care coordination strategies and ways to reduce hospital readmissions.

Other authors of this paper are Charles A. Odonkor, M.D., M.A. Sumit N. Bhatia, M.S., Curtis Leung, M.P.H., Amy Deutschendorf, M.S., R.N., and Daniel J. Brotman, M.D.