Deficits in Discharge Documentation in Patients Transferred to Rehabilitation Facilities on Anticoagulation: Results of a Systemwide Evaluation
Deficits in Discharge Documentation in Patients Transferred to Rehabilitation Facilities on Anticoagulation: Results of a Systemwide Evaluation
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DOI：
10.1016/s1553-7250(08)34057-4
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发表时间：
2008-08-01
影响因子：
2.3
通讯作者：
Schnipper, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Gandara, Esteban;Moniz, Thomas T.;Schnipper, Jeffrey L.
背景：抗凝治疗是治疗多种疾病的常用有效疗法，但需要临床医生之间进行详细沟通，以避免患者出院后出现不良后果。方法：对从 Partners Healthcare System 的所有五家急症护理医院出院到波士顿 30 个亚急症机构的患者样本的出院文件包以及用于治疗或预防血栓栓塞性疾病的处方抗凝治疗进行了评估。所需的数据元素包括有关抗凝适应症、持续时间、剂量、监测和随访的信息。出院文件包是随机选择的，供急性部位的审查人员使用，而亚急性部位的审查人员则选择要审查的文件包。 结果：2005 年 3 月至 2007 年 6 月期间，757 名患者在出院时接受抗凝治疗，治疗持续时间（普通肝素或低分子量肝素 [UFH/LMWH]）以及近期剂量和监测信息（华法林）是缺陷最大的领域。在接受 UFH/LMWH 或华法林治疗的患者中，分别有 45.4% 和 16.4% 的患者在出院小结中提供了所有必需的信息。与从学术医疗中心出院的患者相比，从社区医院出院的患者出院时更有可能掌握使用华法林（比值比 [OR]，2.56；95% 置信区间 [CI]，1.20-5.46）或 UFH/LMWH（OR，2.97；95% CI，1.98-4.44）所需的所有信息。 讨论：出院后安全处方抗凝治疗的重要信息从急性医院转移到亚急性机构的患者的出院摘要中经常缺失。未来的研究应侧重于开发、实施和评估质量改进干预措施，以弥补这一差距。
Background: Anticoagulation is a commonly prescribed and effective therapy for several medical conditions but requires detailed communication among clinicians to avoid adverse patient outcomes following hospital discharge.Methods: Discharge documentation packets of a sample of patients discharged from all five acute care hospitals of the Partners Healthcare System to 30 subacute facilities in Boston and prescribed anticoagulation for treatment or prophylaxis of thromboembolic disease were evaluated. Required data elements included information on anticoagulation indication, duration, dosing, monitoring, and follow-up. Discharge documentation packets were randomly selected for reviewers at acute sites, whereas reviewers at subacute sites selected which packets to review.Results: Of 757 patients prescribed anticoagulation at discharge from March 2005 through June 2007, duration of therapy (for unfractionated or low-molecular-weight heparin [UFH/LMWH]) and recent dosing and monitoring information (for warfarin) were the areas with the biggest deficits. Of the patients prescribed UFH/LMWH or warfarin, 45.4% and 16.4%, respectively, had all the required information in the discharge summary. Patients discharged from community hospitals were more likely to be discharged with all the information needed for the use of warfarin (Odds Ratio [OR], 2.56; 95% confidence interval [CI], 1.20-5.46) or UFH/LMWH (OR, 2.97; 95% CI, 1.98-4.44) than patients discharged from academic medical centers.Discussion: Important information to safely prescribe anticoagulation after discharge was often missing from the discharge summaries of patients transferred from acute hospitals to subacute facilities. Future research should focus on developing, implementing, and evaluating quality improvement interventions to address this gap.