Kashiwagi, Deanne T.

Background Prompt, complete, and accurate information transfer at the time of discharge between hospital-based and primary care providers (PCPs) is needed for the provision of safe and effective care. Purpose of the Study To evaluate timeliness, quality, and interventions to improve timeliness and quality of hospital discharge summaries. Data Sources PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus database published in English between January 2007 and February 2014 were searched. We also hand-searched bibliographies of relevant articles. Study Selection Observational studies investigating transfer of information at hospital discharge (n = 7) and controlled studies evaluating interventions to improve timeliness and quality of discharge information (n = 12) were included. Data Extraction We extracted data on availability, timeliness, and content of hospital discharge summaries and on the effectiveness of interventions targeting discharge summaries. Results of studies are presented narratively and using descriptive statistics. Data Synthesis Across the studies, discharge summaries were completed within 48 hours in a median of 67% and were available to PCPs within 48 hours only 55% of the time. Most of the time, discharge summaries included demographics, primary diagnosis, hospital course, and discharge instructions. However, information was limited to pending test results (25%), diagnostic tests performed (60%), and postdischarge medications (78%). In 6 interventional studies, implementation of electronic discharge summaries was associated with improvement in timeliness but not quality. Conclusions Delayed or insufficient transfer of discharge information between hospital-based providers and PCPs remains common. Creation of electronic discharge summaries seems to improve timeliness and availability but does not consistently improve quality.

BACKGROUNDFailures in communication at the time of patient handoff have been implicated as contributing factors to preventable adverse events.OBJECTIVEExamine the relationship between face‐to‐face handoffs and the rate of patient outcomes, including adverse events.DESIGNRetrospective cohort.SETTINGA 1157‐bed academic tertiary referral hospital.PATIENTSThere were 805 adult patients admitted to general internal medicine services.INTERVENTIONRetrospective comparison of clinical outcomes, including the rate of adverse events, of patients whose care was transitioned with and without face‐to‐face handoffs.MEASUREMENTSRapid response team calls, code team calls, transfers to a higher level of care, death in hospital, 30‐day readmission rate, length of stay, and adverse events (as identified using the Global Trigger Tool).RESULTSThere was no significant difference with respect to the frequency of rapid response team calls, code team calls, transfers to a higher level of care, deaths in hospital, length of stay, 30‐day readmission rate, or adverse events between patients whose care was transitioned with or without a face‐to‐face handoff.CONCLUSIONSFace‐to‐face handoff of patients admitted to general medical services at a large academic tertiary referral hospital was not associated with a significant difference in measured patient outcomes, including the rate of adverse events, compared to a non–face‐to‐face handoff. Additional study is needed to determine the qualities of patient handoff that optimize efficiency and safety. Journal of Hospital Medicine 2015;10:137–141. © 2015 Society of Hospital Medicine

This study is a retrospective chart review to determine the association of Charlson Comorbidity Index (CCI), age, body mass index (BMI), and admission glucose with the incidence of postoperative 30-day mortality in older patients undergoing hip fracture surgery from January 1, 2000, to June 30, 2002. A total of 40 (8%) of 485 eligible patients died within 30 days after hip fracture surgery. The factors associated with 30-day mortality were age > 90 years (odds ratio [OR] = 2.74; confidence interval [CI] = 1.27-5.95; P = .012), BMI < 18.5 (OR = 3.98; CI 1.48-10.65; P = .006), and CCI ≥ 6 (OR = 2.6; CI = 1.20-5.65; P = .015). There was no relationship between admission glucose concentration and 30-day mortality. Advanced age, low BMI, and high CCI can be identified prospectively and are independently associated with postoperative 30-day mortality in older, chronically ill patients.