Timeliness in discharge summary dissemination is associated with patients' clinical outcomes
Timeliness in discharge summary dissemination is associated with patients' clinical outcomes
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DOI：
10.1111/j.1365-2753.2011.01772.x
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发表时间：
2013-02-01
影响因子：
2.4
通讯作者：
Thompson, Campbell H.
中科院分区：
文献类型：
--
作者：
Li, Jordan Y. Z.;Yong, Tuck Y.;Thompson, Campbell H.
基本原理、目的和目标确定普通内科患者的再入院率与出院总结的存在或其分发的及时性之间的关系。方法回顾性分析2005年1月至2009年12月某三级转诊教学医院全科医疗服务的所有出院病例。主要观察指标为出院后7天或28天内的再入院率。结果共纳入16496例患者。在这些出院患者中，3397例（20.6%）患者在出院后一周内未完成总结。患者在7天（P < 0.001）或28天（P < 0.001）内的再入院率与反映其出院总结发送延迟的类别之间存在显著的线性趋势。没有出院小结与7天内再入院率增加79%[95%置信区间（CI）增加42%至124%; P < 0.001]和28天内再入院率增加37%（95% CI增加17%至61%; P < 0.001）相关。如果年龄小于80岁，则出院后7天内再入院率增加127%（95%CI增加72%至202%; P < 0.001），出院后28天内再入院率增加55%（95%CI增加25%至91%; P < 0.001）。结论延迟传输或缺少出院小结与患者再次入院相关，尤其是在80岁以下的患者中。如果在出院后7天内没有生成总结，则出院后7天或28天内的再入院率与根本没有编写总结没有区别。
Rationale, aims and objectives To determine the relation of the readmission rate of general medical patients to either the existence of a discharge summary or the timeliness of its dispatch. Methods This was a retrospective study on discharge summaries of all discharges from the general medical service at a tertiary referral teaching hospital from January 2005 to December 2009. The main outcome measures were readmission rate to hospital within 7 or 28 days of discharge Results A total of 16 496 patient admissions were included in the analysis. Of these discharges, 3397 (20.6%) patients did not have a summary completed within a week of discharge. There were significant linear trends between patients' readmission rates within 7 (P < 0.001) or 28 days (P < 0.001) and categories reflecting the delay in dispatch of their discharge summaries. The absence of a discharge summary was associated with a 79% increase in the rate of readmission within 7 days [95% confidence interval (CI) 42 to 124% increase; P < 0.001] and a 37% increased rate of readmission within 28 days (95% CI 17 to 61% increase; P < 0.001). If aged less than 80 years, the absence of a discharge summary was associated with a 127% increase in readmission rate within 7 days (95% CI 72 to 202% increase; P < 0.001) and a 55% increase within 28 days (95% CI 25 to 91% increase; P < 0.001) after discharge. Conclusions Delayed transmission or absence of a discharge summary is associated with readmission of the patient; more so in patients less than 80 years old. If no summary is generated by 7 days after discharge, the rate of readmission within 7 or 28 days after discharge is indistinguishable from no summary being written at all.