Transition of care for hospitalized elderly patients—Development of a discharge checklist for hospitalists

Abstract

BACKGROUND Discharge from the hospital is a critical transition point in a patient's care. Incomplete handoffs at discharge can lead to adverse events for patients and result in avoidable rehospitalization. Care transitions are especially important for elderly patients and other high‐risk patients who have multiple comorbidities. Standardizing the elements of the discharge process may help to address the gaps in quality and safety that occur when patients transition from the hospital to an outpatient setting. METHODS The Society of Hospital Medicine's Hospital Quality and Patient Safety committee assembled a panel of care transition researchers, process improvement experts, and hospitalists to review the literature and develop a checklist of processes and elements required for ideal discharge of adult patients. The discharge checklist was presented at the Society of Hospital Medicine's Annual Meeting in April 2005, where it was reviewed and revised by more than 120 practicing hospitalists and hospital‐based nurses, case managers, and pharmacists. The final checklist was endorsed by the Society of Hospital Medicine. RESULTS The finalized checklist is a comprehensive list of the processes and elements considered necessary for optimal patient handoff at hospital discharge. This checklist focused on medication safety, patient education, and follow‐up plans. CONCLUSIONS The development of content and process standards for discharge is the first step in improving the handoff of care from the inpatient to the posthospital setting. Refining this checklist for patients with specific diagnoses, in specific age categories, and with specific discharge destinations may further improve information transfer and ultimately affect patient outcomes. Journal of Hospital Medicine 2006;1:354–360. © 2006 Society of Hospital Medicine.

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

“…8 Recognizing the importance of incorporating information about pending tests in discharge summaries, the Society of Hospital Medicine's Quality and Patient Safety Committee included 'all pending labs or tests, [and] the responsible person to whom results will be sent' in a checklist of elements required for an ideal discharge summary. 9 While there is general agreement that discharge summaries should comprehensively document pending tests and the follow-up providers, very few studies have evaluated the adequacy of summaries in this area. Wilson et al found that 36.4% of discharge summaries contained errors or inaccuracies, but gave little specific detail about the accuracy in documenting pending test results or the follow-up provider.…”

Family caregivers as partners in care transitions: The caregiver advise record and enable act

“…If hospital-based clinicians were asked to rank order their daily tasks from greatest sense of professional gratification to lowest, discharge preparation would likely appear toward the bottom of the list. 7,8 Meanwhile, hospitalists and hospital clinical leaders are struggling to keep pace with a confluence of new demands that include value-based purchasing initiatives and population health efforts, to name but a few. Although current Centers for Medicare and Medicaid Services' (CMS) Hospital Conditions of Participation for Discharge Planning do not require recognition or preparation of family caregivers, CMS' newly proposed revisions emphasize better preparation of family caregivers to be active partners upon hospital discharge.…”

Critical conversations: A call for a nonprocedural “time out”

“…Developing formal systems that decrease communication failures in ''high-risk'' circumstances remains a focus in patient safety, evidenced by guidelines for TOs in procedural settings, handoffs in patient care (eg, sign-out between providers), 14,15 and transitions into and from the hospital setting. 16 Furthermore, there is growing evidence that such structured times for communication and teamwork, such as with briefings, can improve efficiency and reduce delays in care. 17,18 However, handoffs, which address provider transitions, and daily multidisciplinary rounds, which bring providers together regularly, are provider-centered rather than patient-centered.…”