July 2017
The Keys to Unlocking a Great Discharge Summary
Physicians and other practitioners need to know details about care a patient receives during an inpatient hospital stay. The hospital discharge summary is the key source for this information.
Studies have shown that providing timely, structured discharge summaries to practitioners favorably impacts readmission rates, patient satisfaction and continuity of care. One study found that at discharge, approximately 40 percent of patients have test results pending and that 10 percent of those require some action.
Primary Care Physicians (PCP) and patients may be unaware of these results1. A prospective cohort study found that one in five patients discharged from the hospital to their homes experienced an adverse event, defined as an injury resulting from medical management rather than from the underlying disease, within three weeks of discharge2. This study found 66 percent of these were drug-related adverse events3.
Key information often missing from discharge summaries includes:
- diagnostic test results
- treatment or hospital course
- discharge medications with reasons for changes
- test results pending at discharge
- follow-up plans
Provider Satisfaction Surveys
The Blue Cross and Blue Shield of Texas (BCBSTX) Provider Satisfaction Surveys include questions about practitioner satisfaction with hospital discharge summaries. Below are the 2015 and 2016 survey results. While solid improvement is seen across the measures, improvements in timelines and content can still be made.
| Survey Question | Goal | BCBSTX 2015 Results | BCBSTX 2016 Results |
| 34. When your patients are admitted to a hospital, are you sent summary information after the discharge? | 85% | 72% | 80% |
| 35. When you receive hospital discharge information, does it reach your office within five business days? | 85% | 80% | 84% |
| 36. When you receive hospital discharge information, does it contain adequate information about medications at discharge? | 85% | 88% | 89% |
| 40. Overall Satisfaction with Continuity of Care | 85% | 76% | 80% |
Communications between the hospital and PCPs is critical to ensure a smooth and durable transition of the patient to the next level of care.
BCBSTX applauds practitioners who have adopted a structured approach to discharge summaries and strongly encourages those who have not to consider adopting this practice.
Sources
1Roy CL, Poon EG, Karson AS, et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005;143(2):121–8.
2 Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161–7.
3 Snow, V., MD. (2009). Transitions of Care Consensus Policy Statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, and Society for Academic Emergency Medicine. Journal of Hospital Medicine, 4(6), 364-370. doi:10.1002