Hospital discharge summaries often delayed; may affect nursing home re-hospitalizations

Summary reports that follow discharged hospital patients to a nursing home are frequently delayed and sometimes incomplete, according to researchers at the University of Wisconsin School of Medicine and Public Health.

The researchers’ findings, recently published in the Journal of General Internal Medicine, determined that discharge summaries regularly lack necessary information on diet, activity level, therapy and pending laboratory tests of nursing home patients after departure from the hospital.

The study involved 489 Medicare patients treated for strokes and hip fractures. All were sent to nursing homes after discharge from the hospital between 2003 and 2005.

According to a requirement from The Joint Commission, which accredits healthcare facilities, hospitals must submit discharge summaries within 30 days after a patient is discharged. These summaries provide details on the patient’s hospital stay and can be especially important to care delivery during the first few days of a patient’s nursing home stay.

The University of Wisconsin researchers, however, found discharge summaries were often completed many days after the patient had already been discharged to the nursing home, some more than 30 days after discharge. In addition, the longer it took to release a discharge summary, the more imprecise the information within the summaries became—if they weren’t downright incomplete.

This forces nursing home caregivers to spend precious time contacting the hospital to determine how to proceed with patient treatment, researchers said.

They also found that nearly a third of discharge summaries did not include information on the patient’s dietary needs. Instructions on therapy and activity needs were excluded on more than 40 percent of discharge summaries, and less than 10 percent included information on pending studies and laboratory tests.

“Right now, the Joint Commission standard for the creation of discharge summaries within 30 days is outdated, because this standard doesn't optimally support patients who need care right after discharge,” researchers said. “Our study is the first to suggest that the quality of the actual document starts getting worse the longer you wait to create a discharge summary. Important items are omitted, and because of that, patient care may suffer”.

“We know that one in five Medicare patients is re-hospitalized within 30 days of discharge,” they added. “Experts suggest that care during the hospital discharge and early post-hospital period may be critical in preventing at least a portion of these re-hospitalizations.”

The study was funded by the University of Wisconsin Health Innovation Program and the National Institutes of Health.

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