Medication reconciliation and discharge communication from hospital to general practice: a quantitative analysis
Melinda Gusmeroli A B , Stephen Perks
A B * and Nicole Bates A
A Townsville University Hospital, Townsville, Qld 4814, Australia.
B James Cook University, Townsville, Qld 4814, Australia.
Australian Journal of Primary Health - https://doi.org/10.1071/PY22232
Submitted: 19 October 2022 Accepted: 20 July 2023 Published online: 14 August 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: The aim of this study was to assess the quality of effective discharge communication to primary practice from a hospital that uses ieMR (integrated electronic Medical Record), a complete electronic prescribing/medical record platform.
Methods: A retrospective quantitative analysis of 232 discharge encounters from a major tertiary hospital assessed the discharge summary quality; timeliness, completeness and medication information.
Results: Median time to discharge summary was 1 day. 22.0% of discharge summaries were incomplete at 30 days post discharge and 44.5% of discharge summaries were incomplete at 30 days post discharge if discharged on a weekend compared to weekday (P-value = 0.001). Rates of medication reconciliation were completed at approximately 35% at each point of the patient stay and 56.9% of patients had a GP discharge summary listing discharge medications. However, if certain progressive steps were completed (i.e. Home Medications recorded in ieMR, Discharge Reconciliation in ieMR, and Patient Discharge Medication Record in eLMs (Enterprise-wide Liaison Medication System)), then, the ‘Medications on Discharge’ was significantly more likely to be present in the discharge summary, at rates of 70.1%, 85.9%, and 98.6% respectively (P-value = 0.007, <0.001, <0.001). Conversely not doing these steps dropped rates of having medications listed in the discharge summary to 50.0%, 40.3% and 34.1% respectively.
Conclusions: This study assessed current discharge summary quality since the introduction of electronic medical records. It demonstrated the significant value of correct use of electronic programs, including performing all crucial steps of reconciliation. Targeted interventions in future studies that rectify the shortfalls in discharge communication are warranted.
Keywords: communication, discharge, discharge summary, health education, medication, medication systems, medication therapy management, pharmacy administration, reconciliation.
References
Australian Bureau of Statistics (2016) Townsville 2016 census all persons QuickStats. Australian Bureau of Statistics. Available at https://www.abs.gov.au/census/find-census-data/quickstats/2016/318 [Accessed 9 June 2022]Australian Bureau of Statistics (2018) Estimates of Aboriginal and Torres Strait Islander Australians. Australian Bureau of Statistics. Available at https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/estimates-aboriginal-and-torres-strait-islander-australians/latest-release [Accessed 9 June 2022]
Australian Commission on Safety and Quality in Health Care (2017) ‘National guidelines for on-screen presentation of discharge summaries.’ (ACSQHC: Sydney)
Australian Commission on Safety and Quality in Healthcare (2017) ‘National safety and quality health service standards.’ (ACSQHC: Sydney)
Australian Commission on Safety and Quality in Healthcare (2022) Medication reconciliation. Australian Commission on Safety and Quality in Healthcare. Available at https://www.safetyandquality.gov.au/our-work/medication-safety/medication-reconciliation [Accessed 16 June 2022]
Balla JI, Jamieson WE (1994) Improving the continuity of care between general practitioners and public hospitals. Medical Journal of Australia 161, 656–659.
| Improving the continuity of care between general practitioners and public hospitals.Crossref | GoogleScholarGoogle Scholar |
Biggs MJ, Biggs TC (2020) Independent prescribing pharmacists supporting the early discharge of patients through completion of medical discharge summaries. Journal of Pharmacy Practice 33, 173–175.
| Independent prescribing pharmacists supporting the early discharge of patients through completion of medical discharge summaries.Crossref | GoogleScholarGoogle Scholar |
Callen JL, Alderton M, McIntosh J (2008) Evaluation of electronic discharge summaries: a comparison of documentation in electronic and handwritten discharge summaries. International Journal of Medical Informatics 77, 613–620.
| Evaluation of electronic discharge summaries: a comparison of documentation in electronic and handwritten discharge summaries.Crossref | GoogleScholarGoogle Scholar |
deClifford J-M, Lam SS, Leung BK (2009) Implementation and acceptance of a pharmacist-initiated E-script transcription service for discharge prescriptions. Journal of Pharmacy Practice and Research 39, 286–289.
| Implementation and acceptance of a pharmacist-initiated E-script transcription service for discharge prescriptions.Crossref | GoogleScholarGoogle Scholar |
Gusmeroli M, Perks S, Lanskey C, Bates N (2023) Australian general practitioners’ views on qualities that make effective discharge communication: a scoping review. Australian Journal of Primary Health
| Australian general practitioners’ views on qualities that make effective discharge communication: a scoping review.Crossref | GoogleScholarGoogle Scholar |
Keable K, Perks S (2022) Rates of discharge reconciliation completion following the rollout of an electronic prescribing interface in two large Queensland hospitals. Pharmacy GRIT.
Kripalani S, Jackson AT, Schnipper JL, Coleman EA (2007a) Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. Journal of Hospital Medicine 2, 314–323.
| Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists.Crossref | GoogleScholarGoogle Scholar |
Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW (2007b) Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 297, 831–841.
| Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care.Crossref | GoogleScholarGoogle Scholar |
Latimer S, Hewitt J, de Wet C, Teasdale T, Gillespie BM (2023) Medication reconciliation at hospital discharge: a qualitative exploration of acute care nurses’ perceptions of their roles and responsibilities. Journal of Clinical Nursing 32, 1276–1285.
| Medication reconciliation at hospital discharge: a qualitative exploration of acute care nurses’ perceptions of their roles and responsibilities.Crossref | GoogleScholarGoogle Scholar |
Newnham H, Barker A, Ritchie E, Hitchcock K, Gibbs H, Holton S (2017) Discharge communication practices and healthcare provider and patient preferences, satisfaction and comprehension: a systematic review. International Journal for Quality in Health Care 29, 752–768.
| Discharge communication practices and healthcare provider and patient preferences, satisfaction and comprehension: a systematic review.Crossref | GoogleScholarGoogle Scholar |
Okoniewska B, Santana M, Groshaus H, Stajkovic S, Cowles J, Chakrovorty D, Ghali W (2015) Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers’ perceptions. Journal of Multidisciplinary Healthcare 8, 83–89.
| Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers’ perceptions.Crossref | GoogleScholarGoogle Scholar |
Stainkey L, Pain T, McNichol M, Hack J, Roberts L (2010) Matched comparison of GP and consultant rating of electronic discharge summaries. Health Information Management Journal 39, 7–15.
| Matched comparison of GP and consultant rating of electronic discharge summaries.Crossref | GoogleScholarGoogle Scholar |
Tandjung R, Rosemann T, Badertscher N (2011) Gaps in continuity of care at the interface between primary care and specialized care: general practitioners’ experiences and expectations. International Journal of General Medicine 4, 773–778.
| Gaps in continuity of care at the interface between primary care and specialized care: general practitioners’ experiences and expectations.Crossref | GoogleScholarGoogle Scholar |
Townsville Hospital and Health Service (2021) Admission, transfer and discharge of patients procedure. Townsville Hospital and Health Service.
Tsopra R, Wyatt JC, Beirne P, Rodger K, Callister M, Ghosh D, Clifton IJ, Whitaker P, Peckham D (2019) Level of accuracy of diagnoses recorded in discharge summaries: a cohort study in three respiratory wards. Journal of Evaluation in Clinical Practice 25, 36–43.
| Level of accuracy of diagnoses recorded in discharge summaries: a cohort study in three respiratory wards.Crossref | GoogleScholarGoogle Scholar |
van Walraven C, Seth R, Austin PC, Laupacis A (2002) Effect of discharge summary availability during post-discharge visits on hospital readmission. Journal of General Internal Medicine 17, 186–192.
| Effect of discharge summary availability during post-discharge visits on hospital readmission.Crossref | GoogleScholarGoogle Scholar |
van Walraven C, Taljaard M, Etchells E, Bell CM, Stiell IG, Zarnke K, Forster AJ (2010) The independent association of provider and information continuity on outcomes after hospital discharge: implications for hospitalists. Journal of Hospital Medicine 5, 398–405.
| The independent association of provider and information continuity on outcomes after hospital discharge: implications for hospitalists.Crossref | GoogleScholarGoogle Scholar |
Wembridge P, Rashed S (2022) Discharge summary medication list accuracy across five metropolitan hospitals: a retrospective medical record audit. Australian Health Review 46, 338–345.
| Discharge summary medication list accuracy across five metropolitan hospitals: a retrospective medical record audit.Crossref | GoogleScholarGoogle Scholar |
