Association between days to complete inpatient discharge summaries with all‐payer hospital readmissions in Maryland

Abstract

OBJECTIVE Hospital discharge summaries can provide valuable information to future providers and may help to prevent hospital readmissions. We sought to examine whether the number of days to complete hospital discharge summaries is associated with 30‐day readmission rate. PATIENTS AND METHODS This was a retrospective cohort study conducted on 87,994 consecutive discharges between January 1, 2013 and December 31, 2014, in a large urban academic hospital. We used multivariable logistic regression models to examine the association between days to complete the discharge summary and hospital readmissions while controlling for age, gender, race, payer, hospital service (gynecology–obstetrics, medicine, neurosciences, oncology, pediatrics, and surgical sciences), discharge location, length of stay, expected readmission rate in Maryland based on diagnosis and illness severity, and the Agency for Healthcare Research and Quality Comorbidity Index. Days to complete the hospital discharge summary—the primary exposure variable—was assessed using the 20th percentile (>3 vs ≤3 days) and as a continuous variable (odds ratio expressed per 3‐day increase). The main outcome was all‐cause readmission to any acute care hospital in Maryland within 30 days. RESULTS Among the 87,994 patients, there were 14,248 (16.2%) total readmissions. Discharge summary completion >3 days was significantly associated with readmission, with adjusted odds ratio (OR) (95% confidence interval [CI]) of 1.09 (1.04 to 1.13, P = 0.001). We also found that every additional 3 days to complete the discharge summary was associated with an increased adjusted odds of readmission by 1% (OR: 1.01, 95% CI: 1.00 to 1.01, P < 0.001). CONCLUSION Longer days to complete discharge summaries were associated with higher rates of all‐cause hospital readmissions. Timely discharge summary completion time may be a quality indicator to evaluate current practice and as a potential strategy to improve patient outcomes. Journal of Hospital Medicine 2016;11:393–400. 2016 Society of Hospital Medicine

Patterns of Hospital Performance on the Hospital-Wide 30-Day Readmission Metric: Is the Playing Field Level?

“…On one hand, the differences in the HWR metric may be true reflections of hospital quality. [21][22][23] This would help to explain why hospitals with large surgical volumes and those providing hospice services had lower readmission rates; large surgical volumes are associated with the Bvolume-out-come^relationship in which a higher volume of patients undergoing a particular procedure at a hospital is associated with better outcomes for those patients, 24 and offering palliative care reduces inpatient care utilization and costs for patients approaching the end of life. [25][26][27] If indeed variation in hospital quality is the main driver for our findings, greater attention must be placed on the types of care defects that may exist at large, urban tertiary care centers and those that care for high-complexity patient populations (such as those with cancer or organ transplants).…”

Information Transfer and the Hospital Discharge Summary: National Primary Care Provider Perspectives of Challenges and Opportunities

“…4 Receipt of a summary by the PCP before the posthospital follow-up visit, as well as inclusion of salient content in the summary, may reduce the risk of adverse events such as hospital readmissions. 9,10 Some study of the interface between hospitalist and PCP has already taken place, confirming the importance of the HDS in this care transition. [11][12][13] To further quantify specific deficits in HDS content and delivery we designed a survey of primary care physicians in the United States.…”

Hospital to Post-Acute Care Facility Transfers: Identifying Targets for Information Exchange Quality Improvement

“…A uniform requirement for discharge summary completion by the time of transfer to PAC would address the identified gap between desired and actual state with regard to timely receipt of discharge summaries, and could potentially reduce hospital readmission rates. 6 Additional targets for improvement identified in this gap analysis include: improved documentation of hospital clinician contact information, pending studies, indication and duration for lines and catheters, code status, need for contact isolation, and medication management. Many of the elements we identified as insufficient are included in existing tools to improve information exchange between acute hospitals to PAC facilities, which will guide future quality improvements.…”

“…Insufficient or untimely information exchange between hospitals and other settings can lead to medication discrepancies, missed test results, and even rehospitalization. 1–6 Optimizing information exchange between hospitals and post-acute care (PAC) facilities accepting patients after hospital discharge is of particular importance because clinicians often need to provide treatments (e.g., antibiotics, pain medications) to patients immediately upon arrival at the PAC facility. In a prior study, 22% of transfers from PAC facilities back to an acute care hospital occurred within six days of admission to the facility, and 11% occurred within 2 days of admission, suggesting failure of care transitions from hospitals to PAC facilities.…”