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Association between discharge summary timeliness and clinical outcomes among general medicine patients
Cutie Kannampuzha1, Yogesh Sharma1,2, Campbell Thompson3
1Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Adelaide, South Australia, Australia.
Background:
Timely discharge summaries are critical for optimal care transitions; however, evidence linking timeliness with patient outcomes remains inconsistent.
Aim:
This study examined the association between summary completion time and 30-day readmission and mortality among general medical patients.
Methods:
This retrospective cohort study at a South Australian tertiary teaching hospital included adult general medical admissions between July 2022 and June 2023. Discharge summaries were categorised as completed within 24 h, 24-48 h or beyond 48 h. The primary outcome was a composite of 30-day readmission or death; secondary outcomes were 30-day readmission and mortality assessed separately. Multivariable logistic regression adjusted for age, sex, comorbidities, frailty and measures of healthcare utilisation with results reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
Results:
Among 4703 admissions, 21.9% had discharge summaries completed more than 48 h after discharge, while 78.1% were completed within 48 h, and 26.8% experienced the composite outcome - these patients were older, with higher comorbidity and frailty (P < 0.05). Discharge summary completion beyond 48 h was independently associated with higher odds of the composite outcome (aOR 1.42, 95% CI 1.13-1.77, P < 0.001) and mortality (aOR 1.95, 95% CI 1.29-2.96, P = 0.002), but not 30-day readmission (aOR 1.14, 95% CI 0.90-1.43, P = 0.622). Among patients who died within 30 days, 51.3% of deaths occurred within a median of 7 days from discharge (interquartile range 3-16).
Conclusions:
Discharge summaries completed after 48 h were associated with adverse 30-day outcomes, particularly mortality. The clustering of death within the first week after discharge highlights the vulnerability of the post-discharge period and underscores the importance of timely communication between hospital and primary care providers.
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