E M A Witherington1, O M Pirzada, A J Avery. 1. Nottingham University Hospitals, City Campus, Hucknall Road, Nottingham NG5 1PB, UK. elizabeth.witherington@nuh.nhs.uk
Abstract
OBJECTIVES: (1) To identify communication gaps at hospital discharge for older people who are readmitted within 28 days; (2) to assess the contribution of incomplete discharge information to readmission; (3) to identify measures that might improve communication at hospital discharge. DESIGN: Retrospective case-note review. SETTING: A teaching hospital in Nottingham, UK. SAMPLE: 108 consecutive patients aged 75 and over who were readmitted as an emergency within 28 days of previous discharge MAIN OUTCOME MEASURES: (1) Proportion of patients discharged with insufficient arrangements and/or information for immediate safe continuity of care; (2) proportion of patients with medication management information missing; (3) proportion of readmissions related to incomplete medication management information and proportion of patients for whom this was preventable. RESULTS: Thirty patients (28%) returned within 3 days of discharge, 48 (44%) within 7 days and the remainder within 28 days. Sixty-seven (62%) patients either had no discharge letter or returned before the letter was typed. Documentation of changes in medication was incomplete on two-thirds of all discharge documents. Readmission was considered to be related to medication for 41 (38%) patients and to be preventable for 25 (61%) of these. There were preventable discharge communication gaps, including monitoring information, for 22 (54%) of these patients. CONCLUSION: Incomplete documentation at discharge was common, particularly for medication management. It is likely that communication gaps contributed to many of the preventable adverse events and readmissions.
OBJECTIVES: (1) To identify communication gaps at hospital discharge for older people who are readmitted within 28 days; (2) to assess the contribution of incomplete discharge information to readmission; (3) to identify measures that might improve communication at hospital discharge. DESIGN: Retrospective case-note review. SETTING: A teaching hospital in Nottingham, UK. SAMPLE: 108 consecutive patients aged 75 and over who were readmitted as an emergency within 28 days of previous discharge MAIN OUTCOME MEASURES: (1) Proportion of patients discharged with insufficient arrangements and/or information for immediate safe continuity of care; (2) proportion of patients with medication management information missing; (3) proportion of readmissions related to incomplete medication management information and proportion of patients for whom this was preventable. RESULTS: Thirty patients (28%) returned within 3 days of discharge, 48 (44%) within 7 days and the remainder within 28 days. Sixty-seven (62%) patients either had no discharge letter or returned before the letter was typed. Documentation of changes in medication was incomplete on two-thirds of all discharge documents. Readmission was considered to be related to medication for 41 (38%) patients and to be preventable for 25 (61%) of these. There were preventable discharge communication gaps, including monitoring information, for 22 (54%) of these patients. CONCLUSION: Incomplete documentation at discharge was common, particularly for medication management. It is likely that communication gaps contributed to many of the preventable adverse events and readmissions.
Authors: Sunil Kripalani; Terry A Jacobson; Ileko C Mugalla; Courtney R Cawthon; Kurt J Niesner; Viola Vaccarino Journal: J Hosp Med Date: 2010 May-Jun Impact factor: 2.960
Authors: John W Showalter; Colleen M Rafferty; Nicole A Swallow; Kolapo O Dasilva; Cynthia H Chuang Journal: J Gen Intern Med Date: 2011-04-16 Impact factor: 5.128
Authors: Tamasine C Grimes; Catherine A Duggan; Tim P Delaney; Ian M Graham; Kevin C Conlon; Evelyn Deasy; Marie-Claire Jago-Byrne; Paul O' Brien Journal: Br J Clin Pharmacol Date: 2011-03 Impact factor: 4.335