Hospital to Post‐Acute Facility Transfers: A Gap Analysis of Targets for Quality Improvement

1University of Colorado School of Medicine, Aurora, CO
2University of Colorado —
Anschutz Medical Campus, Aurora, CO
3UNC School of Medicine, Chapel Hill, NC
4VA Eastern CO Heathcare system, Denver, CO

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 159

Background:

Information exchange is critical to high‐quality care transitions, yet little is known about the quality of information transfer from hospitals to post‐acute care facilities. To evaluate the quality of information transfer from a tertiary care University Hospital to post‐acute care facilities, we performed a cross‐sectional survey of post‐acute care clinicians and staff.

Methods:

During the fall of 2013, we submitted a web‐based 36‐question survey to 109 employees of 30 facilities that provide the highest volume post‐hospitalization acute care for the hospital. The survey explored different aspects of care coordination, including the timeliness of access to medical records and the completeness of information provided. Respondents could select answers from a 4‐ or 5‐point Likert scale as well as enter free‐text comments.

Results:

56 individuals from 23 facilities responded to the survey (response rate: individuals 51%, facilities 77%). Among 56 respondents, 6 (11%) were physicians, 1 (2%) was a physician’s assistant, 3 (5%) were nurses, 5 (9%) were administrators, 16 (29%) worked in admissions, 12 (21%) were clinical liaisons, 11 (20%) held other positions (e.g., business/marketing, social services), and 2 (4%) did not respond to this question.

We found that 27% of respondents indicated “occasionally” or “rarely” having access to sufficient information from the hospital about a patient’s discharge medical conditions and management. In addition, 15% of respondents indicated encountering problems related to not having adequate information about a patient “often” to “almost always.”

The most common insufficient discharge communication items were: how to contact the appropriate hospital clinician with questions (41%), follow up plans for labs or imaging studies pending at the time of discharge (40%), indication and planned duration for lines or catheters (37%), and advanced directives/code status (31%).

Although 70% of respondents reported having access to a discharge summary on or prior to the day of a patient’s discharge, 90% of respondents believed that they should have access to a discharge summary during this timeframe – a 20% differential between real‐world and desired timeliness of access to discharge summaries. Finally, nearly all respondents (96%) indicated that internet‐based access to the hospitals electronic medical record (EMR) would be “important” or “very important” to help manage patients.

Conclusions:

In this study, we performed a unique survey of post‐acute care facilities in which we identified quality gaps in the completeness and timeliness of medical information provided to post‐acute facilities. As a next step, individuals at these facilities will be provided with internet‐based access to the hospital EMR. We plan to repeat this survey 6 months following implementation of internet‐based EMR access to determine which components of information exchange improve with this intervention and which remain to be improved.

To cite this abstract:

Jones C, Cumbler E, Honigman B, DeWalt D, Coleman E, Burke R, Wald H. Hospital to Post‐Acute Facility Transfers: A Gap Analysis of Targets for Quality Improvement. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 159. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/hospital-to-postacute-facility-transfers-a-gap-analysis-of-targets-for-quality-improvement/. Accessed May 26, 2019.

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