How to Avoid Fumbled Handoffs When Discharging Patients

One of the most important lessons that I learned as a Girl Scout was: "Be Prepared." Whether it was preparing for a camping trip as a scout or later reporting and writing an article as a journalist, it's proved to be an important motto for living everyday life.

And, it's an important motto that hospitals and healthcare organizations are finding that they need to consider when communicating with discharged patients: Make sure those patients are prepared with sufficient information about their conditions in the post-discharge world concerned about 30-day readmissions.

Consider a new study by researchers from the Regenstrief Institute and the Indiana University School of Medicine that found that hospital discharge summaries were extremely inadequate in documenting both tests with pending results and information about which doctors should receive those test results.

The researchers noted that this poor communication could lead to serious medical errors.

Often during hospital stays, tests may be ordered by emergency department physicians, generalists, specialists, hospitalists, and other medical staff. These test results could indicate anything from a positive blood culture to declining kidney function, they said.

These are conditions that can require post discharge treatment, but oftentimes the results of some tests may not be ready for weeks after the patient has left the hospital. Most patients may find themselves unprepared: They and their healthcare providers are unaware that test results are pending—until it might be too late.

In the study, which appears in the September 2009 issue of the Journal of General Internal Medicine, 668 hospital discharges with pending test results were examined. The researchers analyzed the discharge summaries and found them deficient:

• While all of the patients had pending test results—only 16% of the 2,927 tests with pending results were mentioned in the discharge summaries.
• Only 67% of discharge summaries indicated which primary care outpatient physician would be responsible for following up with the patient after discharge.

Since the researchers examined the discharge summaries retrospectively, they were able to see if test results reported after discharge called for changes in a patient treatment plan or in management. What they did discover surprised them.