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Hospital Discharge Summaries Are Insufficient Following ICU Stays: A Qualitative Study
Katrina E Hauschildt1, Rachel K Hechtman2, Hallie C Prescott1,2
1Veterans Affairs Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI.
Abstract:
Primary care providers (PCPs) receive limited information about their patients' ICU stays; we sought to understand what additional information PCPs desire to support patients' recovery following critical illness.
Design:
Semistructured interviews with PCPs conducted between September 2020 and April 2021.
Setting:
Academic health system with central quaternary-care hospital and associated Veterans Affairs medical center.
Subjects:
Fourteen attending internal medicine or family medicine physicians working in seven clinics across Southeast Michigan (median, 10.5 yr in practice).
Main Outcomes And Measures:
We analyzed using a modified Rigorous and Accelerated Data Reduction (RADaR) technique to identify gaps in current discharge summaries for patients with ICU stays, impacts of these gaps, and desired ICU-specific information. We employed RADaR to efficiently consolidate data in Excel Microsoft (Redmond, WA) tables across multiple formats (lists, themes, etc.).
Results:
PCPs reported receiving limited ICU-specific information in hospital discharge summaries. PCPs often spent significant time reading inpatient records for additional information. Information desired included life-support interventions provided and duration (mechanical ventilation, dialysis, etc.), reasons for treatment decisions (code status changes, medication changes, etc.), and potential complications (delirium, dysphagia, postintensive care syndrome, etc.). Pervasive discharge gaps (ongoing needs, incidental findings, etc.) were described as worse among patients with ICU stays due to more complex illness and required interventions. Insufficient information was felt to lead to incomplete follow-up on critical issues, PCP frustration, and patient harm. PCPs stated that the COVID-19 pandemic exacerbated gaps due to decreased staffing, limited visitation policies, and reliance on telehealth follow-up visits.
Conclusions And Relevance:
Our results identified key data elements sought by PCPs about patients' ICU stays and suggest opportunities to improve care through developing tools/templates to provide PCPs with ICU-specific information for outpatient follow-up.
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