A systematic literature review and narrative synthesis on the risks of medical discharge letters for patients’ safety

Abstract

Background: Healthcare systems worldwide have adopted the electronic medical record (EMR). EMRs are an efficient method of interprofessional communication, and can improve data availability for secondary research purposes. The discharge summary (DS) is a crucial document for both interprofessional communication, and coding of data for research purposes. We aimed to assess the completeness of our EMRs by assessing the presence of a DS in the EMR. Additionally, we evaluated the presence of indicators for a missing DS. Method: A retrospective chart review was conducted on 3,011 inpatient charts from 3 hospitals in Calgary, Alberta Canada. 893 charts were missing an electronic DS. A 10% sample was drawn to assess for presence of a paper DS. A list of variables was compiled to assess for association between patient and hospital characteristics, patient comorbidities, and the absence of an electronic DS. A Chi-square test, Fisher's test and logistic regression were conducted to assess for associations. Results: The univariate analyses showed that age, being a surgical patient, a Charlson Comorbidity Index (CCI) of </1, as well as patients with myocardial infarctions, congestive heart failure, cerebrovascular disease, dementia, chronic pulmonary disease, diabetes, and renal disease were associated with a missing DS. The multivariate logistic regression showed that those that were middle aged, surgical patients, or with fewer comorbidities were more likely to have a missing DS. Within the 10% sample, approximately 50% of all patients were from a surgical department, all of which were missing both electronic and paper discharge summaries. Conclusion: Our study is the first to describe indicators associated with missing electronic discharge summaries. There is a modern day propensity for adoption of the EMR across healthcare systems worldwide. The EMR, especially the DS, is used for the improvement of interprofessional communication, patient outcomes, and data quality. Therefore, the implications of an incomplete EMR are widespread. Our findings will caution future researchers using EMR data about the potential for incomplete data, particularly for patients who are surgical, middle aged, and have fewer comorbidities. Additionally, our study highlights the need for further investigation into the lack of discharge summaries in surgical units.

Pharmacist–Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability

“…Medical discharge summaries, or discharge letters, are a key communication tool for patient safety [1]. Australian national indicators for quality use of medicines in hospitals state that all discharge summaries should include "a current, accurate and comprehensive list of medicines" and "medication therapy changes and explanations for changes" [2].…”

“…It is widely recognised, in Australia and internationally, that discharge summaries prepared by hospital physicians (including medical interns, junior medical officers and senior medical staff) often include incomplete or incorrect medication information [1,3,4]. Medication lists may be inaccurate, and medication changes made in hospital are often not documented, or they may be documented but not explained [3,[5][6][7][8][9][10].…”

“…Many strategies to improve the quality of medication information in discharge summaries have been trialed, including guidelines, performance indicators, physician education and discharge summary templates with specific sections for medication information [3,8,15]. However, poor quality of discharge medication information persists [1,4,8,16]. Electronic discharge summaries (EDSs) have the potential to improve the accuracy of discharge summary data, especially if they are integrated with electronic prescribing systems, but studies comparing EDSs with handwritten discharge summaries have produced variable results [17].…”

Investigating discharge communication for chronic disease patients in three hospitals in India

“…[7,[13][14][15][16][17][18] However, in practice the delivery of discharge instructions often remains rushed and essential details for facilitating continuity of care such as diagnosis, medication, lifestyle and follow-up information are not always exchanged. [13,[19][20][21][22][23][24] Despite the growing body of literature on quality of discharge communication and its impact on HCP and patient-related outcomes in HICs, similar evidence from low and middleincome countries (LMICs) remains relatively scarce. [25] Some single-site observational studies have evaluated discharge practices and found issues regarding deficient documentation, guidelines, standardised procedures and patient education.…”

Writing outpatient letters to patients

“…A large proportion of patient complaints and litigation originate from poor communication 4. Correspondence that is delayed, not patient centred, and lacking information has been highlighted as a risk to patient safety 5. Writing prompt letters directly to patients can help reduce these risks 6…”