Communication gaps and readmissions to hospital for patients aged 75 years and older: observational study.
OBJECTIVE
(1) To identify communication gaps at hospital discharge for older people who are readmitted within 28 days; (2) to assess the contribution of incomplete discharge information to readmission; (3) to identify measures that might improve communication at hospital discharge.


METHODS
Retrospective case-note review.


METHODS
A teaching hospital in Nottingham, UK.


METHODS
108 consecutive patients aged 75 and over who were readmitted as an emergency within 28 days of previous discharge


METHODS
(1) Proportion of patients discharged with insufficient arrangements and/or information for immediate safe continuity of care; (2) proportion of patients with medication management information missing; (3) proportion of readmissions related to incomplete medication management information and proportion of patients for whom this was preventable.


RESULTS
Thirty patients (28%) returned within 3 days of discharge, 48 (44%) within 7 days and the remainder within 28 days. Sixty-seven (62%) patients either had no discharge letter or returned before the letter was typed. Documentation of changes in medication was incomplete on two-thirds of all discharge documents. Readmission was considered to be related to medication for 41 (38%) patients and to be preventable for 25 (61%) of these. There were preventable discharge communication gaps, including monitoring information, for 22 (54%) of these patients.


CONCLUSIONS
Incomplete documentation at discharge was common, particularly for medication management. It is likely that communication gaps contributed to many of the preventable adverse events and readmissions.
Witherington
E M A
EM
Nottingham University Hospitals, City Campus, Hucknall Road, Nottingham NG5 1PB, UK. elizabeth.witherington@nuh.nhs.uk
Pirzada
O M
OM
Avery
A J
AJ
D000368:Aged; D000369:Aged, 80 and over; D003144:Communication Barriers; D003266:Continuity of Patient Care / Q000458:organization & administration; D004282:Documentation; D064420:Drug-Related Side Effects and Adverse Reactions; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D012189:Retrospective Studies; D006113:United Kingdom