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Effect of discharge summary availability during post-discharge visits on hospital readmission
Carl van Walraven1, Ratika Seth, Peter C Austin
1Department of Medicine, University of Ottawa, Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa, ON, Canada. carlw@ohri.ca
Objective:
To determine if the delivery of hospital discharge summaries to follow-up physicians decreases the risk of hospital readmission.
Subjects:
Eight hundred eighty-eight patients discharged from a single hospital following treatment for an acute medical illness.
Setting:
Teaching hospital in a universal health-care system.
Design:
We determined the date that each patient's discharge summary was printed and the physicians to whom it was sent. Summary receipt was confirmed by survey and phoning each physician's office. Each patient's hospital chart was reviewed to determine their acute and chronic medical conditions as well as their course in hospital. Using population-based administrative databases, all post-hospitalization visits were identified. For each of these visits, we determined whether the summary was available.
Main Outcome Measures:
Time to nonelective hospital readmission during 3 months following discharge.
Results:
The discharge summary was available for only 568 of 4,639 outpatient visits (12.2%). Overall, 240 (27.0%) of patients were urgently readmitted to hospital. After adjusting for significant patient and hospitalization factors, we found a trend toward a decreased risk of readmission for patients who were seen in follow-up by a physician who had received a summary (relative risk 0.74, 95% confidence interval 0.50 to 1.11).
Conclusions:
The risk of rehospitalization may decrease when patients are assessed following discharge by physicians who have received the discharge summary. Further research is required to determine if better continuity of patient information improves patient outcomes.