Communication gaps and readmissions to hospital for patients over 75 years and older: an observational study.
Evidence to support medicines management interventions that prevent or reduce hospital readmissions is rare. This research paper describes the findings of a small observational study in Nottingham. The researchers used a retrospective case note review to identify factors that could lead to medicines-related hospital readmissions in older people following hospital discharge.
What is the background to this?
The National Institute for Health and Clinical Excellence recently published a patient safety solution recommending action on communication of medicines information on admission of adults to hospital. This paper concludes that communication problems can also occur when patients are discharged. Poor communication has the potential to result in readmissions which could have been prevented. In the study group of 108 people readmitted to hospital, documentation of changes to medication was incomplete on two-thirds of previous discharge documents. Readmission was considered to be medicines-related in 41 (38%) of the 108 cases examined and preventable in 25 (61%) of this sub-group.
The authors suggest a number of improvements that could be made. These include:
- Systematic recording of changes to medication during an admission with reasons given for any changes made
- Pre-discharge reviews to identify possible adverse events resulting from medication changes
- Considering the discharge process as a “referral” back to primary care with adequate information to ensure continuity of care
- Further research to identify other interventions to improve communication
How does this relate to other publications or evidence?
There are relatively few published studies that consider medicines-related hospital admissions or readmissions. Of these, only a small number relate to the UK and the NHS environment. The National Prescribing Centre has published its own guide to medicines reconciliation. This covers communication of medicines information at various interfaces of care and proposes a minimum dataset of medicines information that should be transferred with the patient.
Reducing waiting times, length of stay and readmissions are important NHS priorities. This paper provides evidence that relatively simple interventions, when applied systematically, have the potential to have an impact on these priorities. There are also indirect benefits to both patients and the NHS such as reducing the amount of time people stay in hospital, reduced use of NHS resources, lower risk of hospital acquired infections and more efficient use of staff time.
There are opportunities to improve communications about medicines across interfaces of care with the potential to achieve benefits for patients and the NHS. One approach might be to promote medicines reconciliation; this could be achieved through commissioning agreements between commissioners and local providers. Area prescribing committees could provide local leadership by establishing local medicines management policies that include sections on improving communication across interfaces of care.
Witherington EMA, Pirzada OM, Avery AJ. Communication gaps and readmissions to hospital for patients over 75 years and older: an observational study. Qual Saf Health Care 2008; 17: 71-75