RT Journal Article
SR Electronic
T1 Hospital discharge documentation and risk of rehospitalisation
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 773
OP 778
DO 10.1136/bmjqs.2010.048470
VO 20
IS 9
A1 Luke O Hansen
A1 Amy Strater
A1 Lisa Smith
A1 Jungwha Lee
A1 Robert Press
A1 Norman Ward
A1 John A Weigelt
A1 Peter Boling
A1 Mark V Williams
YR 2011
UL http://qualitysafety.bmj.com/content/20/9/773.abstract
AB Background Avoidable hospital readmission is a focus of quality improvement efforts. The effectiveness of individual elements of the standard discharge process in reducing rehospitalisation is unknown.Methods The authors conducted a case-control study of 1039 patients experiencing rehospitalisation within 30 days of discharge and 981 non-rehospitalised patients matched on admission diagnosis, discharge disposition, and severity of illness. In separate models for each discharge process component, the authors measured the relationship between readmission and discharge summary completion, contents of discharge summary, completion of discharge instructions, contents of discharge instructions, presence of caregiver for discharge instruction, completion of medication reconciliation, and arrangement of ambulatory follow-up prior to discharge.Results Adjusting for patient and hospital characteristics, including severity of illness and discharge disposition, the study failed to find an association between readmission and most components of the discharge process. There was no association between readmission and medication reconciliation, transmission of discharge summary to an outpatient physician, or documentation of any specific aspect of discharge instruction. Associations were found between readmission and discharge with followup arranged (adjusted odds ratio (OR) 1.21; 95% CI 1.05 to 1.37) and increasing number of medicines (adjusted OR 1.02; 95% CI 1.01 to 1.04).Conclusions Documentation of discharge process components in the medical record may not reflect actual discharge process activities. Alternatively, mandated discharge processes are ineffective in preventing readmission. The observed absence of an association between discharge documentation and readmission indicates that discharge quality improvement initiatives should target metrics of discharge process quality beyond improving rates of documentation.