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Discharge Communication Practices for Children With Medical Complexity: A Retrospective Chart Review
Margaret Rush1, Nicole Herrera2, Anjna Melwani3
1Divisions of Hospitalist Medicine and mrush3@childrensnational.org.
Insights
Discharge communication between hospitalists and primary care providers (PCPs) was documented for only 59% of children with medical complexity (CMC). Communication was less frequent for technology-dependent children, highlighting a need for improved care coordination.
Area of Science:
- Pediatric Hospital Medicine
- Healthcare Communication
- Patient Safety
Background:
- Children with medical complexity (CMC) face higher risks of adverse events post-hospitalization.
- Existing research on discharge communication primarily focuses on adults and general pediatric populations.
- There is a significant gap in understanding hospitalist communication practices for CMC at discharge.
Purpose of the Study:
- To investigate hospitalist-to-primary care provider (PCP) communication practices for CMC at hospital discharge.
- To identify factors influencing the documentation and quality of discharge communication for CMC.
Main Methods:
- Retrospective chart review at a tertiary children's hospital.
- Inclusion of patients with ≥1 complex chronic condition discharged by the pediatric hospitalist team.
- Descriptive analysis using statistical tests (χ², t test, Wilcoxon rank) and odds ratios to assess communication differences.
Main Results:
- Discharge communication was documented in 59% of 368 eligible CMC encounters.
- Communication was less likely for technology-dependent children (P=.01), older patients (P=.02), and those on teaching services (P=.04).
- Discharge summary quality did not differ based on technology dependence.
Conclusions:
- Discharge communication with PCPs is less frequently documented for technology-dependent CMC.
- Hospitalists may face barriers to timely and appropriate discharge communication for CMC.
- Implementing consistent handoff processes is crucial for improving care coordination for CMC.
Objectives:
Children with medical complexity (CMC) have an increased risk of adverse events after hospital discharge. Authors of previous studies have evaluated discharge communication practices with primary care providers (PCPs) in adults and general pediatric patients. There is a lack of evidence surrounding hospitalist communication practices at discharge for CMC. In this study, we explore hospitalist-to-PCP communication for CMC at hospital discharge.
Methods:
A retrospective chart review was performed at a single tertiary care children's hospital. The population included patients with ≥1 complex chronic condition who were discharged from the pediatric hospitalist team. The presence, type, and quality of discharge communication were collected. A descriptive analysis in which we used χ2, t test, Wilcoxon rank testing, and odds ratios was conducted to identify differences in communication practices in CMC.
Results:
We identified 368 eligible patients and reviewed their electronic medical records. Discharge communication was documented for 59% of patient encounters. Communication was less likely to occur for patients with technology dependence (P = .01), older patients (P = .02), and those who were admitted to a teaching service (P = .04). The quality of discharge summaries did not change for patients with technology dependence compared with patients without technology dependence.
Conclusions:
Communication with the PCP at discharge was less likely to be documented in children with technology dependence. Hospitalists may encounter barriers in completion of appropriate and timely discharge communication with PCPs for CMC. Consistent handoff processes could be used to improve care for our patients with enhanced coordination needs.
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