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Commission to Build a Healthier America Public Meeting
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Tying Up Loose Ends
Discharging Patients with Unresolved Medical Issues
The current research examined how often physicians recommended outpatient workups to discharged patients and subsequent completion rates for the recommended workups. Researchers first reviewed inpatient records at a single hospital over an 18-month period to ascertain the nature of recommended workups. Outpatient records were inspected for evidence of workup completion in the six months post discharge.
Key Findings:
- There were 693 patients discharged; 191 (27.6%) involved post discharge workup recommendations.
- Workup recommendations included diagnostic procedures (47.9%), subspecialty referrals (35.4%), and outpatient laboratory tests (16.7%).
- The diagnostic procedure recommended most often was computed tomographic scans. Cardiologists were the most common subspecialty referral. The outpatient laboratory test recommended most often was anticoagulation monitoring.
- Slightly over one-third (36%) of recommended workups were completed.
- Laboratory testing workups were completed most often (85%), while diagnostic procedural workups were completed least often (50.4%). There was a significant difference in workup completion rate.
- More time to first follow-up visit after discharge and longer hospitalization stays were related to lower likelihood of recommended workup completion. Discharge summaries with workup recommendations raised the likelihood of workup completion post discharge.