Discharge documentation of patients discharged to subacute facilities: a three-year quality improvement process across an integrated health care system.
BACKGROUND
Effective communication among physicians during hospital discharge is critical to patient care. Partners Healthcare (Boston) has been engaged in a multi-year process to measure and improve the quality of documentation of all patients discharged from its five acute care hospitals to subacute facilities.


METHODS
Partners first engaged stakeholders to develop a consensus set of 12 required data elements for all discharges to subacute facilities. A measurement process was established and later refined. Quality improvement interventions were then initiated to address measured deficiencies and included education of physicians and nurses, improvements in information technology, creation of or improvements in discharge documentation templates, training of hospitalists to serve as role models, feedback to physicians and their service chiefs regarding reviewed cases, and case manager review of documentation before discharge. To measure improvement in quality as a result of these efforts, rates of simultaneous inclusion of all 12 applicable data elements ("defect-free rate") were analyzed over time.


RESULTS
Some 3,101 discharge documentation packets of patients discharged to subacute facilities from January 1, 2006, through September 2008 were retrospectively studied. During the 11 monitored quarters, the defect-free rate increased from 65% to 96% (p < .001 for trend). The largest improvements were seen in documentation of preadmission medication lists, allergies, follow-up, and warfarin information.


CONCLUSIONS
Institution of rigorous measurement, feedback, and multidisciplinary, multimodal quality improvement processes improved the inclusion of data elements in discharge documentation required for safe hospital discharge across a large integrated health care system.
Gandara
Esteban
E
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, USA.
Ungar
Jonathan
J
Lee
Jason
J
Chan-Macrae
Myrna
M
O'Malley
Terrence
T
Schnipper
Jeffrey L
JL
D001900:Boston; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards*; D004282:Documentation / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D010351:Patient Discharge / Q000592:standards*; D010360:Patient Transfer / Q000458:organization & administration / Q000592:standards; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration / Q000592:standards; D012189:Retrospective Studies; D019467:Subacute Care / Q000458:organization & administration / Q000592:standards