Pending laboratory tests and the hospital discharge summary in patients discharged to sub-acute care.
BACKGROUND
Previous studies have noted a high (41%) prevalence and poor discharge summary communication of pending laboratory (lab) tests at the time of hospital discharge for general medical patients. However, the prevalence and communication of pending labs within a high-risk population, specifically those patients discharged to sub-acute care (i.e., skilled nursing, rehabilitation, long-term care), remains unknown.


OBJECTIVE
To determine the prevalence and nature of lab tests pending at hospital discharge and their inclusion within hospital discharge summaries, for common sub-acute care populations.


METHODS
Retrospective cohort study.


METHODS
Stroke, hip fracture, and cancer patients discharged from a single large academic medical center to sub-acute care, 2003-2005 (N = 564)


METHODS
Pending lab tests were abstracted from the laboratory information system (LIS) and from each patient's discharge summary, then grouped into 14 categories and compared. Microbiology tests were sub-divided by culture type and number of days pending prior to discharge.


RESULTS
Of sub-acute care patients, 32% (181/564) were discharged with pending lab tests per the LIS; however, only 11% (20/181) of discharge summaries documented these. Patients most often left the hospital with pending microbiology tests (83% [150/181]), particularly blood and urine cultures, and reference lab tests (17% [30/181]). However, 82% (61/74) of patients' pending urine cultures did not have 24-hour preliminary results, and 19% (13/70) of patients' pending blood cultures did not have 48-hour preliminary results available at the time of hospital discharge.


CONCLUSIONS
Approximately one-third of the sub-acute care patients in this study had labs pending at discharge, but few were documented within hospital discharge summaries. Even after considering the availability of preliminary microbiology results, these omissions remain common. Future studies should focus on improving the communication of pending lab tests at discharge and evaluating the impact that this improved communication has on patient outcomes.
Department of Population Health Sciences, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA. sewalz@wisc.edu
Stacy E
SE
Walz
Maureen
M
Smith
Elizabeth
E
Cox
Justin
J
Sattin
Amy J H
AJ
Kind
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000592:standards / Q000639:trends*; D003955:Diagnostic Tests, Routine / Q000592:standards / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards / Q000639:trends*; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D019467:Subacute Care / Q000592:standards / Q000639:trends*