Improving the continuity of care following discharge of patients hospitalized with heart failure: is the discharge summary adequate?

OBJECTIVE: To determine the adequacy of the discharge summary in reporting important investigative results and future management plans in patients hospitalized and discharged with a diagnosis of heart failure.

DESIGN: During a six-month period, all patient charts were identified and reviewed in which heart failure had been the most responsible discharge diagnosis. Trained, independent chart reviewers recorded predefined key aspects of the typed and handwritten discharge summaries including measurement of left ventricular function, utilization of angiotensin-converting enzyme inhibitors (ACEI), management of risk factors, and instructions for follow-up treatment and appointments.

SETTING: Single centre, tertiary care teaching hospital.

MAIN RESULTS: One hundred and one patient charts meeting review criteria were identified. Eighty-two contained a typed (dictated) discharge summary and 82 contained a copy of a one-page preformatted but handwritten summary given to the patient at discharge with instructions to give to their primary care physician. Forty-one per cent of typed discharge summaries did not record any known evaluation of left ventricular ejection fraction (LVEF). Of patients with LVEF < or =40%, 34% were not prescribed an ACEI at time of discharge. Of these patients, a contraindication was documented in 26% but there was no documentation of a contraindication or reason in 24%. In patients with ischemic cardiomyopathy as the principal attributed cause of heart failure, 80% of discharge summaries had no specific instructions addressing modifiable risk factors. Follow-up instructions for family physician visits were not mentioned in 56% of typed discharge summaries.

CONCLUSIONS: Substantial inadequacies exist in communicating to the community physician, at the time of discharge from an acute care teaching hospital, valuable patient management information of patients with heart failure. This may have implications for continuity of care and subsequent clinical outcomes.