Heart failure discharge summaries miss mark

With Medicare penalties now at 3 percent for 30-day heart failure readmissions, many hospitals are eager to find opportunities to improve outcomes. Based on a study published online Jan. 13, discharge summaries might fit the bill.

Mohammed Salim Al-Damluji, MD, of Yale School of Medicine in New Haven, Conn., and colleagues postulated that the summaries prepared at a heart failure patient’s discharge could facilitate the transition of care as well as serve as a document of the hospital visit. Summaries might hold useful information for outpatient care, if they are timely, pertinent and sent to the appropriate clinician.

They explored hospital-level performance for timeliness, transmission and content of discharge summaries using the Telemonitoring to Improve Heart Failure Outcomes study, which was designed to assess the effectiveness of telemonitoring for patients living at home after an index heart failure admission. For this analysis, they obtained 1,501 summaries from 46 hospitals; 35 percent provided more than 10 summaries.

They categorized quality under three domains— timeliness, transmission and content—based on recommended elements by the Joint Commission and the Transitions of Care Consensus Conference. They found that 67.2 percent of summaries were prepared on the day of discharge, 11 percent within three days of discharge and 7.3 percent more than 30 days after discharge.  

Of the 1,211 summaries that included notations on transitions and follow-up clinicians, 38.3 percent explicitly made reference to being sent to the clinician scheduled for the follow-up. Summaries prepared by physician extenders and attending physicians were more likely to be sent to follow-up physicians than were summaries from trainees (66 percent and 52.9 percent, respectively, vs. 23.5 percent).

Summaries completed on the same day as discharge had the highest likelihood of being transmitted, as were those completed at a nonteaching hospital compared with teaching hospitals and minor teaching hospitals.

Almost all of the discharge summaries included information about discharge medications but only 30.7 percent detailed discharge condition and 0.8 percent listed the discharge physician’s phone number.

On average, the summaries contained 4.11 of the five Joint Commission composite elements and 3.75 of the seven Transitions of Care Consensus Conference-endorsed elements. One third of the summaries covered all five Joint Commission composite elements yet none had all seven of the Transitions of Care Consensus Conference elements.

“No discharge summary met all 3 quality criteria of timeliness, transmission, and content,” they wrote. “Most importantly, we observed considerable variation among hospitals in their practices.”  

Al-Damluji et al acknowledged that in some circumstances other aspects of patient care may take precedence over writing discharge summaries. Still, their results highlighted deficiencies that might be addressed with training, policy changes, formal processes for discharge summaries and auditing, they wrote.

They published their results in Circulation: Cardiovascular Quality and Outcomes.