Hospital Discharge Summaries Done Right Can Reduce Readmissions

When discharge summaries contain detailed information and are sent quickly to primary care physicians, they can help reduce hospital readmissions, according to studies from researchers at Yale School of Medicine.

While discharge summaries are meant to help outside physicians understand what happened to the patient in the hospital, they are often merely used as an aid for medical billing, according to the investigators.

“The medical community hasn’t really made full use of discharge summaries as a tool for transitions,” lead author Leora Horwitz, MD, MHS, adjunct associated professor of internal medicine at Yale School of Medicine and director of the Center for Healthcare Innovation and Delivery Science at New York University Langone Medical Center, said in a statement.

The 2 studies both looked at data from the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) study, which contained more than 1500 discharge summaries from 46 hospitals across the country for patients hospitalized with heart failure.

In the first study, Dr Horowitz and her team found that hospitals varied widely in their performance and no hospital consistently produced high-quality summaries in all domains. Even high-performing hospitals had discharge summaries that were considered insufficient because of timeliness, transmission, and content—3 key factors needed in order for the summary to do its job of making the transition from hospital to home safer. The content was based on the suggested 7 components from the Transitions of Care Consensus Conference.

While hospital course was included in 97.2% of the summaries, only 30.7% included discharge condition; 16%, discharge volume status; and 15.7%, discharge weight. Hospitals contributing 10 or more summaries typically included 3.6 of the 7 Transitions of Care Consensus Conference elements, and no hospital included all 7.

The second study also used the Tele-HF study. This time they found that when the quality of the discharge summaries was improved, readmission rates were affected for the better. Patients with summaries that included useful content or were sent to outside clinicians had lower readmission rates, they found.

“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,” said Dr Horowitz.