Deficits in discharge documentation in patients transferred to rehabilitation facilities on anticoagulation: results of a systemwide evaluation.
BACKGROUND
Anticoagulation is a commonly prescribed and effective therapy for several medical conditions but requires detailed communication among clinicians to avoid adverse patient outcomes following hospital discharge.


METHODS
Discharge documentation packets of a sample of patients discharged from all five acute care hospitals of the Partners Healthcare System to 30 subacute facilities in Boston and prescribed anticoagulation for treatment or prophylaxis of thromboembolic disease were evaluated. Required data elements included information on anticoagulation indication, duration, dosing, monitoring, and follow-up. Discharge documentation packets were randomly selected for reviewers at acute sites, whereas reviewers at subacute sites selected which packets to review.


RESULTS
Of 757 patients prescribed anticoagulation at discharge from March 2005 through June 2007, duration of therapy (for unfractionated or low-molecular-weight heparin [UFH/LMWH]) and recent dosing and monitoring information (for warfarin) were the areas with the biggest deficits. Of the patients prescribed UFH/LMWH or warfarin, 45.4% and 16.4%, respectively, had all the required information in the discharge summary. Patients discharged from community hospitals were more likely to be discharged with all the information needed for the use of warfarin (Odds Ratio [OR], 2.56; 95% confidence interval [CI], 1.20-5.46) or UFH/LMWH (OR, 2.97; 95% CI, 1.98-4.44) than patients discharged from academic medical centers.


CONCLUSIONS
Important information to safely prescribe anticoagulation after discharge was often missing from the discharge summaries of patients transferred from acute hospitals to subacute facilities. Future research should focus on developing, implementing, and evaluating quality improvement interventions to address this gap.
Gandara
Esteban
E
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, USA. egandara@partners.org
Moniz
Thomas T
TT
Ungar
Jonathan
J
Lee
Jason
J
Chan-Macrae
Myrna
M
O'Malley
Terrence
T
Schnipper
Jeffrey L
JL
D000925:Anticoagulants / Q000627:therapeutic use*; D003266:Continuity of Patient Care; D004282:Documentation; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008404:Massachusetts; D008485:Medical Audit; D009096:Multi-Institutional Systems; D010351:Patient Discharge / Q000592:standards*; D010360:Patient Transfer; D011787:Quality of Health Care; D012047:Rehabilitation Centers; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin