title: Hospital discharge communications during care transitions for patients with acute kidney injury: a cross-sectional study.
abstract: High quality hospital discharge communications about acute kidney injury (AKI) could facilitate continuity of care after hospital transitions and reduce patients' post-hospitalization health risks.
  
  
  
  We characterized the presence and quality (10 elements) of written hospital discharge communications (physician discharge summaries and patient instructions) for patients hospitalized with AKI at a single institution in 2012 through medical record review.
  
  
  
  In 75 randomly selected hospitalized patients with AKI, fewer than half of physician discharge summaries and patient instructions documented the presence (n = 33, 44 % and n = 10, 13 %, respectively), cause (n = 32, 43 % and n = 1, 1 %, respectively), or course of AKI (n = 23, 31 %, discharge summary only) during hospitalization. Few provided recommendations for treatment and/or observation specific to AKI (n = 11, 15 and 6, 8 % respectively). In multivariable analyses, discharge communications containing information about AKI were most prevalent among patients with AKI Stage 3, followed by patients with Stage 2 and Stage 1 (adjusted percentages (AP) [95 % CI]: 84 % [39-98 %], 43 % [11-82 %], and 24 % [reference], respectively; p trend = 0.008). AKI discharge communications were also more prevalent among patients with known chronic kidney disease (CKD) versus those without (AP [95 % CI]: 92 % [51-99 %] versus 39 % [reference], respectively, p = 0.02) and among patients discharged from medical versus surgical services (AP [95 % CI]: 73 % [33-93 %] versus 23 % [reference], respectively, p = 0.01). Communications featured 4 median quality elements. Quality elements were greater in communications for patients with more severe AKI (Stage 3 (number of additional quality elements (β) [95 % CI]: 2.29 [0.87-3.72]), Stage 2 (β [95 % CI]: 0.62 [-0.65-1.90]) and Stage 1 (reference); p for trend = 0.002).
  
  
  
  Few hospital discharge communications in AKI patients described AKI or provided recommendations for AKI care. Improvements in the quality of hospital discharge communications to improve care transitions of patients with AKI are needed.
authors: Division of General Internal Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Room 2-626, Baltimore, MD, 21287, USA. rfcharle@jhmi.edu.|Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA. rfcharle@jhmi.edu.
authors: Raquel C
authors: RC
authors: Greer
authors: Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, USA.
authors: Yang
authors: Y
authors: Liu
authors: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA.|Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, USA.
authors: Deidra C
authors: DC
authors: Crews
authors: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA.|Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, USA.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.|Nephrology Center of Maryland, Baltimore, USA.
authors: Bernard G
authors: BG
authors: Jaar
authors: Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, USA.
authors: Hamid
authors: H
authors: Rabb
authors: Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
authors: L Ebony
authors: LE
authors: Boulware
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy; D000328:Adult; D000368:Aged; D003142:Communication; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D051436:Renal Insufficiency, Chronic
keywords: Acute kidney injury; Hospitalizations; Transitions of care