A Yale University research team has described what constitutes a good hospital discharge, based on its analysis of 1,500 discharge summaries from patients with exacerbations of heart failure at 46 hospitals enrolled in TeleMonitoring to Improve Heart Failure Outcomes (TELE-HF), a large multicenter study of patients hospitalized with heart failure.
“We consider a good discharge to be a three-legged stool composed of timeliness, transmission to the right person, and having the right components, as defined by The Joint Commission and the Transitions of Care Consensus Conference,” says co-author Leora Horwitz, MD, MHS, director of the Center for Healthcare Innovation and Delivery Science at New York University.
“This study tells us for the first time that it is actually worth spending the time and effort to improve discharge communication, and patients do seem to benefit.”—Leora Horwitz, MD, MHS
Historically, discharge summaries were used primarily for billing, but the medical community has not made full use of them as tools for transition or considered what was really needed by the physician who will see the patient next, Dr. Horwitz says. In a previous study at Yale, as many as a third of discharge summaries were never received by a follow-up physician, and only 15% included the patient’s discharge weight—an essential detail for managing their cardiac care.
A second study using the TELE-HF data found that when the quality of the discharge summary was improved, readmissions rates were lower.
“This study tells us for the first time that it is actually worth spending the time and effort to improve discharge communication, and patients do seem to benefit,” Dr. Horwitz says.
Individual physicians should feel empowered by the result to work on system change in their hospitals, she says.
Larry Beresford is a freelance writer in Alameda, Calif.