General practice processing of hospital discharge summaries for older adults resulted in 21.3% of requested actions not being completed, leading to errors in 12.5% of patients and harm in 4.4%.
Cohort (n=263)
Yes
General practice processing of hospital discharge summaries for older adults has a high rate of incomplete actions (21.3%), leading to preventable harms and readmissions, particularly in vulnerable patients with dementia.
Background: Most hospital admissions are older patients, who are more likely to be medically complex. Primary care risks after hospital discharge and readmission trajectories are relatively unexplored. Aim: To estimate the frequency and nature of errors and harms linked to discharge summary processing in general practice for patients aged ≥65 years and explore associations with readmission and healthcare utilisation from a novel primary care data source. Design and Setting: Retrospective cohort study using electronic health records (EHRs) from seven purposively sampled general practices in the West Midlands, UK. Method: We reviewed EHRs for 263 patients aged ≥65 years discharged between October 2022-2023. Outcomes included post-discharge healthcare utilisation and costs, frequency and type of discharge actions, error rates (failures to complete requested actions), harms (severity, attribution, preventability), and 90-day readmissions. Multivariable logistic regression identified predictors of errors, harms and readmission. Results: 186/263 discharged patients (70.7%) accessed post-discharge care; with 47/263 patients 17.5% (95% CI: 13.7-23.0%) having related readmissions within 90 days. The 263 discharge summaries requested 551 actions; 21.3% were not completed, over half involving medications. 12.5% of patients experienced error, 4.4% experienced harm. Most harms were preventable and resulted in hospital readmission. Error/harm disproportionately affected patients with dementia or recorded carer. Conclusion: General practice needs to review their processes for responding to patient discharge information in order to improve patient safety post-discharge. Further research into tools to assist practice with transitions is warranted.
Klepacz et al. (Thu,) conducted a cohort in Hospital discharge in older adults (n=263). General practice discharge summary processing was evaluated on Failure to complete requested discharge actions (errors). General practice processing of hospital discharge summaries for older adults resulted in 21.3% of requested actions not being completed, leading to errors in 12.5% of patients and harm in 4.4%.