Pending Studies at Hospital Discharge: A Pre-post Analysis of an Electronic Medical Record Tool to Improve Communication at Hospital Discharge

Background

Achieving safe transitions of care at hospital discharge requires accurate and timely communication. Both the presence of and follow-up plan for diagnostic studies that are pending at hospital discharge are expected to be accurately conveyed during these transitions, but this remains a challenge.

Objective

To determine the prevalence, characteristics, and communication of studies pending at hospital discharge before and after the implementation of an electronic medical record (EMR) tool that automatically generates a list of pending studies.

Design

Pre-post analysis.

Patients

260 consecutive patients discharged from inpatient general medicine services from July to August 2013.

Intervention

Development of an EMR-based tool that automatically generates a list of studies pending at discharge.

Main Measures

The main outcomes were prevalence and characteristics of pending studies and communication of studies pending at hospital discharge. We also surveyed internal medicine house staff on their attitudes about communication of pending studies.

Key Results

Pre-intervention, 70 % of patients had at least one pending study at discharge, but only 18 % of these were communicated in the discharge summary. Most studies were microbiology cultures (68 %), laboratory studies (16 %), or microbiology serologies (10 %). The majority of study results were ultimately normal (83 %), but 9 % were newly abnormal. Post-intervention, communication of studies pending increased to 43 % (p < 0.001).

Conclusions

Most patients are discharged from the hospital with pending studies, but in usual practice, the presence of these studies has rarely been communicated to outpatient providers in the discharge summary. Communication significantly increased with the implementation of an EMR-based tool that automatically generated a list of pending studies from the EMR and allowed users to import this list into the discharge summary. This is the first study to our knowledge to introduce an automated EMR-based tool to communicate pending studies.KEY WORDS: Applied informatics, Care transitions, Electronic health records, Continuity of care, Health information technology, Hospital medicine, Medical informatics, Patient safety, Quality improvement, Communication