title: Omission of dysphagia therapies in hospital discharge communications.
abstract: Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting. The aim of this study was to examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk subacute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations. We performed a retrospective cohort study that included all stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to subacute care from 2003 through 2005 from a single large academic medical center (N=187). Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included dietary (food and liquid), postural/compensatory techniques (e.g., chin tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist). Forty-five percent of discharge summaries omitted all SLP dysphagia recommendations. Forty-seven percent (88/186) of patients with SLP dietary recommendations, 82% (93/114) with postural, 100% (16/16) with rehabilitation, 90% (69/77) with meal pacing, 95% (21/22) with medication, and 79% (96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries. Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to subacute care.
authors.affiliation: Geriatrics Section, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 2500 Overlook Terrace, Madison, WI 53705, USA. ajk@medicine.wisc.edu
authors.forename: Amy
authors.initials: A
authors.lastname: Kind
authors.forename: Paul
authors.initials: P
authors.lastname: Anderson
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hind
authors.forename: JoAnne
authors.initials: J
authors.lastname: Robbins
authors.forename: Maureen
authors.initials: M
authors.lastname: Smith
mesh_terms: D000046:Academic Medical Centers; D003266:Continuity of Patient Care; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D007297:Inpatients; D019300:Medical Errors; D010351:Patient Discharge / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D020521:Stroke / Q000150:complications*; D014481:United States