Patient Discharge Summary Imperative for Care Coordination

Author: 
Asare Christian, MD

In our current civil environment, it’s unimaginable to purchase an operating system without a manual or guide as to how it functions, its safety features and other potential for harm. However, the most  complex system known — the human body, which has significant vulnerability during acute or prolonged hospitalization or trauma — is at times transferred to other levels of care without clear instructions as to how best to manage for better outcomes and minimize patient harm.

Discharge summaries allow clinicians to do the right thing at the right time for our patients. They also reduce stress, anxiety and inefficiency in work flow. In several states in the U.S., it is mandated that health organizations provide discharge summaries at the time of discharge for patients who are going to another level of care. That is not the case in Pennsylvania, unfortunately.

Fragmentation of care or the absence of coordinated care has been sighted as a significant source of patient harm and high health-care costs by the Institute of Medicine. Research shows that even at the highest performing health systems, discharge summary quality is sub-optimal in terms of timeliness, transmission and content.

Sharing of patient information (either with the patient or health-care provider) is now widely accepted as a form of care delivery. Furthermore, care coordination is an important pillar in the National Quality Strategy Priorities. Delayed or inaccurate transfer information across levels of care has huge implications for safety, re-admission, efficiency and other dimensions of quality proposed by the Institute of Medicine.

By all measures, persons being transferred or needing acute rehabilitation are more vulnerable, with significant medical complications compared to those being discharged to home. (In fact, CMS requires that a patient have a complex medical need and functional impairment before approving care at an acute-rehabilitation hospital.) Yet significant disparities exist between data advocating for high-quality and timely discharge summaries for these populations with functional impairments and disabilities.

Extensive literature exists on the topic of care transition and discharge summaries from acute care to home discharge, but little to no research exists on the safety implications from acute hospital to acute rehabilitation or sub-acute rehabilitation. It is important therefore that locally relevant research is conducted to inform policy makers and health-care financiers.

As we move to value-based care (quality at an affordable price), the need to improve care for the most expensive populations (high need, high cost) becomes an important driver in health-care delivery and financing. In addition, with an aging population and its associated functional decline, a growing number of people will need some form of rehabilitation across level of cares.

The state of Pennsylvania has the challenge and opportunity to lead care quality through better policies, system designs and appropriate incentives to improve care for our high-cost, high-need population. There is no simple solution to the problem of discharge summaries from acute hospitals to acute or sub-acute rehabilitation centers.  But if a Men’s Warehouse in Pennsylvania can instantly pull information about my preferences and a purchase I made in Massachusetts seven months earlier, our billion dollar health electronic systems should be designed to achieve the minimum of creating a high-quality, standardized discharge summary when a patient transitions to another level of care.

If you are interested in learning more about my research into achieving the timely transmission of discharge summaries, please contact me at achristian@gsrh.org. My research goal is collaborative work across local care settings, which will harness collective intelligence for a common goal.