POOR COMMUNICATION IN HOSPITAL READMISSIONS

Discharging and readmitting physicians communicated on only about half the patients who returned within 2 weeks.

When patients who are discharged from a hospital are readmitted, do the discharging and readmitting medical teams communicate with each other? To examine this issue, researchers at two Boston teaching hospitals surveyed residents and attending physicians about patients who required short-term readmission after being discharged from general medicine services.

Of 432 consecutive patients who were discharged and readmitted within the next 14 days, 123 had common providers on both teams, and 84 had planned readmissions; thus, 225 cases were analyzed. Discharging teams were aware that their patients had been readmitted in only 49% of cases, and communication occurred between teams in only 44% of cases. When communication did not occur, 61% of respondents believed that communication would have been beneficial.

Comment by Allan S. Brett, MD: These results won’t surprise physicians who work in systems in which hospitalist or resident-attending teams rotate every few weeks.
Better communication likely would enhance quality of care: In caring for hospitalized patients, we learn valuable medical and psychosocial information that doesn’t always appear in discharge summaries. Failure to communicate also results in lost learning opportunities: We surely learn valuable lessons when we see what happens to our patients shortly after hospital discharge. Creating systems to ensure communication between discharging physicians and readmitting physicians simply makes good sense.

Other articles on Hospital readmissions: physician awareness and communication practices.

Roy CL et al J Gen Intern Med. 2009 Mar;24(3):374-80. Epub 2008 Nov 4.Physicians are frequently unaware of patient readmissions and often do not communicate when readmissions occur. This communication is often desired and frequently results in the exchange of important patient information. Further work is needed to design systems to address this potential discontinuity of care.

Inform Prim Care. 2008;16(2):147-55.Design and implementation of a web-based patient portal linked to an electronic health record designed to improve medication safety: the Patient Gateway medications module.

Schnipper JL et al. This module allows patients to view and modify the list of medications and allergies from the EHR, report non-adherence, side effects and other medication-related problems and easily communicate this information to providers, who can verify the information and update the EHR as needed. Usage and satisfaction data indicate that patients found the module easy to use, felt that it led to their providers having more accurate information about them and enabled them to feel more prepared for their forthcoming visits.

J Gen Intern Med. 2008 Sep;23(9):1414-22. Epub 2008 Jun 19.Classifying and predicting errors of inpatient medication reconciliation.
Pippins JR et al.

Unintentional medication discrepancies are common and more often due to errors taking an accurate medication history than errors reconciling this history with patient orders. Focusing on accurate medication histories, on potential medication errors at discharge, and on identifying high-risk patients for more intensive interventions may improve medication safety during and after hospitalization.

J Am Med Inform Assoc. 2008 Jul-Aug;15(4):424-9. Epub 2008 Apr 24 A randomized trial of electronic clinical reminders to improve medication laboratory monitoring.
Matheny ME They identified high rates of inappropriate laboratory monitoring. Electronic reminders did not significantly improve these monitoring rates. Future studies should focus on settings with lower baseline adherence rates and alternate drug-laboratory combinations.