Yale. US: For heart failure patients making the transition from hospital to
home, a discharge summary that gets to their primary doctors quickly and
contains detailed and useful information can mean the difference
between recovering quickly or returning to the hospital, according to
new research from Yale School of Medicine researchers.
The
findings are part of two studies published by the Yale research team in
the current issue of Circulation: Cardiovascular Quality and Outcomes.
In
theory, a discharge summary is meant to help outside physicians
understand what happened to patients while they were hospitalized, but
in practice, it has served as an aid for medical billing, according to
lead author Dr. Leora Horwitz,
adjunct associate professor of internal medicine at Yale School of
Medicine and director of the Center for Healthcare Innovation and
Delivery Science at New York University Langone Medical Center. “The
medical community hasn’t really made full use of discharge summaries as a
tool for transitions,” she said.
Horwitz and her team analyzed
data from Telemonitoring to Improve Heart Failure Outcomes (Tele-HF), a
large multicenter study of patients hospitalized with heart failure.
This data contained more than 1,500 discharge summaries from 46
hospitals across the country. Horwitz said in order for a discharge
summary to do the job of making the transition from hospital to home
safer, it needs three key factors: It has to be timely, it has to be
sent to the outside physician, and it has to include useful information.
“It’s like a three-legged stool,” she said. “All three need to be
present in order for it to do its job.”
In the first study,
Horwitz and her team expected the summaries to be similar at all the
hospitals they analyzed, but they found that hospitals varied widely in
their performance. And even at the highest-performing hospitals, the
quality of discharge summaries was insufficient in terms of timeliness,
transmission, and content. No hospital consistently produced
high-quality summaries in all domains.
In the second study using
the same data from Tele-HF, the team looked at whether improving
hospital practices regarding discharge summaries made a difference in
hospital readmissions. They found that discharge summary quality was
indeed associated with readmission risk; patients whose summaries
included useful content or were sent to outside clinicians had lower
readmission rates.
“This study tells us for the first time that it
is actually worth spending the time and effort to improve discharge
communication, and patients do seem to benefit,” said Horwitz.
Other
authors on the two studies include first author Dr. Mohammed Salim
Al-Damluji; Kristina Dzara; Beth Hodshon; Dr. Natdanai Punnanithinont; Dr. Harlan M. Krumholz; and Dr. Sarwat I. Chaudhry.
The
studies were funded in part by the National Heart, Lung, and Blood
Institute; The National Institute on Aging; the American Federation for
Aging Research through the Paul B. Beeson Career Development Awards in
Aging Research Program; and the Center for Cardiovascular Outcomes
Research at Yale. Horwitz is also a recipient of the Clinical and
Translational Science Award from Yale Center for Clinical Investigation.
Citations: Circ Cardiovasc Qual Outcomes