IMPROVEMENT IN 24-HOUR DISCHARGE SUMMARY COMPLETION RATE DOES NOT CORRELATE WITH REDUCED READMISSIONS

Abey Thomas, MD*;Saurin Patel, MD;Frances Lehman, RN BSN;Michael Scott Duncan-Batson, LVN and Jonathan Weissler, M.D., University of Texas Southwestern, Dallas, TX

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 269

Categories: Research Abstracts, Transitions of Care

Keywords:

Background: Multiple studies have established that delays in discharge summary transmission were associated with higher rates of all-cause hospital readmissions.    It has been recently shown that delaying the completion of discharge summaries beyond 72 hours increased the risk of 30-day readmissions by 9%.  We had embarked on an initiative to improve the rate of discharge summaries completed and communicated to primary physicians within 24 hours of hospital discharge from the hospitalist service at a University Hospital. Preliminary data during a run-in period demonstrated an improvement from 76% to 85% in 24- hour completion and this was associated with a reduction in 30 day readmission rate from 20% to 16%.Methods: We prospectively studied the effect of the intervention over a 10 month period encompassing 3990 discharges.  The intervention involved setting new formal expectations for the hospitalist team, and monitoring of discharge summary completion by two Transitions of Care Nurses with reminders to complete when necessary.  As a control we compared the readmission of patients on teaching services, staffed primarily by hospitalists but where the residents were responsible for completion of discharge summaries (n= 1260)

Results: 24-hour discharge summary completion rate was significantly higher using a dedicated program on the hospitalist service (90% vs 82%, p<0.05). No statistically significant effect on 30 day all-cause readmission rate (16.6% vs 17.6%) was observed.  Furthermore, there was no difference in 7 day readmission rate (6.0% vs 5.2%), or 7 day return to ER (4.0% vs 3.2%) between hospitalist and teaching ward services.

Conclusions: Our data demonstrates that while the timeliness of discharge summaries can be improved by a dedicated program, this does not correlate with a reduction in readmission rate or return to ER following discharge.  No observable improvement to the 30-day readmission rate or the rate at which patients revisited the ER/ were readmitted within 7 days (which is being seen as possibly a better indicator of quality of care transition) was found with reduction in time to discharge summary completion.  We infer that there could likely be diminishing returns to targeting a discharge summary turnaround time that is significantly less than 72 hours. Additionally, programs to improve timeliness of discharge summary completion on teaching services will be necessary to achieve standards which have been proposed as a quality metric.

To cite this abstract:

Thomas, A; Patel, S; Lehman, F; Duncan-Batson, MS; Weissler, J . IMPROVEMENT IN 24-HOUR DISCHARGE SUMMARY COMPLETION RATE DOES NOT CORRELATE WITH REDUCED READMISSIONS. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 269. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/improvement-in-24-hour-discharge-summary-completion-rate-does-not-correlate-with-reduced-readmissions/. Accessed November 15, 2019.

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