Adequacy of Hospital Discharge Summaries in Documenting Tests with Pending Results and Outpatient Follow-up Providers

Abstract

BACKGROUND: Poor communication of tests whose results are pending at hospital discharge can lead to medical errors.OBJECTIVE: To determine the adequacy with which hospital discharge summaries document tests with pending results and the appropriate follow-up providers. DESIGN:Retrospective study of a randomly selected sample PATIENTS: Six hundred ninety-six patients discharged from two large academic medical centers, who had test results identified as pending at discharge through queries of electronic medical records. INTERVENTION AND MEASUREMENTS:Each patient's discharge summary was reviewed to identify whether information about pending tests and follow-up providers was mentioned. Factors associated with documentation were explored using clustered multivariable regression models.MAIN RESULTS: Discharge summaries were available for 99.2% of 668 patients whose data were analyzed. These summaries mentioned only 16% of tests with pending results (482 of 2,927). Even though all study patients had tests with pending results, only 25% of discharge summaries mentioned any pending tests, with 13% documenting all pending tests. The documentation rate for pending tests was not associated with level of experience of the provider preparing the summary, patient's age or race, length of hospitalization, or duration it took for results to return. Follow-up providers' information was documented in 67% of summaries.CONCLUSION: Discharge summaries are grossly inadequate at documenting both tests with pending results and the appropriate follow-up providers.KEY WORDS: tests with pending results; continuity of care; patient safety; discharge summary; medical errors.

Impact of Automated Alerts on Follow-Up of Post-Discharge Microbiology Results: A Cluster Randomized Controlled Trial

“…7,8 However, this communication process is often hindered by inpatient clinician unawareness of pending test results 1 , and failure to provide the PCPs with discharge summaries 9,10 or list pending tests in the discharge summaries. 2,11 Clinicians are often dissatisfied with their systems to manage test results, 12,13 and health information technology has the potential to assist clinicians in this important aspect of patient care. [14][15][16] One study found that 38/533 (7.1%) positive post-discharge non-urine microbiology results that were reviewed led to initiation, prolongation or change of antimicrobial therapy in the outpatient setting.…”

Detecting Delayed Microbiology Results After Hospital Discharge: Improving Patient Safety Through an Automated Medical Informatics Tool

“…In fact, approximately 41% of patients discharged from the hospital have pending laboratory test results, 1,2 and the most common results requiring urgent action come from pending microbiology tests. Results of a delayed positive culture commonly require initiation of or change in antimicrobial therapy 1,3 ; however, only a fraction of pending microbiology tests are actually documented on the hospital dismissal summary. 3 Strategies are therefore needed to improve both the recognition of delayed test results and the communication of such results to the appropriate health care professional providing care to the patient.…”

“…Results of a delayed positive culture commonly require initiation of or change in antimicrobial therapy 1,3 ; however, only a fraction of pending microbiology tests are actually documented on the hospital dismissal summary. 3 Strategies are therefore needed to improve both the recognition of delayed test results and the communication of such results to the appropriate health care professional providing care to the patient. Computerized information systems are gaining increasing recognition as a valued tool for reducing medical errors.…”

Filling the Black Hole of Hospital Discharge (Editorial in Response to Article by Walz et al., J Gen Intern Med 2011)

“…Of these, only 20 (11%) of the discharge summaries provided documentation of these pending tests. While prior studies 5,6 have reported relatively poor documentation of tests pending at discharge, this study is the first to examine a population of patients being discharged to another facility-a situation in which one might expect documentation to be stronger since there is a receiving institution. With the publication of this paper, the black hole of hospital discharge becomes a little inkier.…”