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Table 2 Included studies

From: A systematic literature review and narrative synthesis on the risks of medical discharge letters for patients’ safety

Author/ Country/ Year study published/Reference Study design Outcome Source of potential risk to patient safety
Mehta, England (2017) [43]
Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: A before and after study.
Before and after longitudinal study design, retrospective analysis of discharge summaries for completeness (N = 773). Introduction of a NewEDS (New Electronic Discharge System).
Completeness and timeliness of hospital discharge communication.
Risk of delay
Risk of lack of information
Maher, Ireland (2013) [50]
Use of mobile applications for hospital discharge letters - improving handover at point of practice.
Experimental study (involving fourth-year medical students) (N = 80). Introduction CLAS (Cork Letter-Writing Assessment Scale) checklist; quality of discharge letters written by medical students. Lack of education
O’Leary, USA (2009) [40]
Creating a better discharge summary: improvement in quality and timeliness using an electronic discharge summary.
Survey of medical specialists (outpatient practice), satisfaction with timeliness and quality of summary (N = 196). Presence or absence of 16 components with a summary score for completeness and timeliness, clarity and overall quality using (5-point Likert scales). Lack of quality
Risk of delay
Weiskopf, USA (2013) [66]
Sick patients have more data: the non-random completeness of electronic health records.
Comparison of completeness of EHR (electronic health record) and Physical Classification score in randomly selected patients (N = 5000). Relationship between EHR (Electronic Health Record) completeness and patient health status. Risk of lack of information
Grimes, Ireland (2008) [30]
Survey of medication documentation at hospital discharge: Implications for patient safety and continuity of care.
Observational study of cardiology patients admitted over a 3-month period during which a pharmacist prospectively recorded details of medication inconsistencies (N = 139). Discrepancies in medication documentation at discharge. Risk of lack of information
Risk of low quality
Chan, Australia (2014) [41]
Improving the efficiency of discharge summary completion by linking to pre-existing patient information databases.
Interventional study. Transfer of electronic data to the discharge summary program improved discharge summary completion rates; reduction in overtime costs (N = 10). 1.) Time spent working on discharge summaries.
2.) Time junior medical doctors worked from which hours of overtime was calculated.
3.) Hours of overtime the junior medical doctor claimed.
4.) Proportion of discharge summaries completed within forty-eight hours of patient discharge.
Risk of delay
Lehnbom, Australia (2014) [42]
Do electronic discharge summaries contain more complete medication information? A retrospective analysis of paper versus electronic discharge summaries.
Retrospective analysis of paper and electronic discharge summaries (N = 199/200). Completeness of medication information, medication changes during the admission, impact of incomplete information on continuity of care. Risk of lack of information
Risk of low quality in medication information
Bergkvist, Sweden (2009) [37]
Improved quality in the hospital discharge summary reduces medication errors-LIMM: Landskrona Integrated Medicines Management.
Longitudinal study with an intervention group and a control group; clinical pharmacists reviewed and gave feedback to the physician on the discharge summary before patient discharge using a structured checklist. Interventional group: (N = 52) Control group: (N = 63). Quality of the discharge summary including the medication report and reduction of medication errors in the transition from hospital to primary and community care. Risk of low quality
Yemm, England (2014) [39]
What constitutes a high-quality discharge summary? A comparison between the views of secondary and primary care doctors.
Anonymous survey (N = 74) junior doctors at a UK (United Kingdom) general hospital and local GPs (N = 153). Ranking discharge summary key content and characteristics in order of importance (f.e. Accuracy, Completeness, Timeliness, Grammar, Medication changes…). Risk of low quality
Risk of lack of information
Risk of delay
Uitvlugt, The Netherlands (2015) [31]
Completeness of medication-related information in discharge letters and post-discharge general practitioner overviews.
Observational study (N = 99). Number and percentage of complete medication-related information in the discharge letter and the GP-overview were compared to the TPC- (Transitional Pharmaceutical Care) overview. Risk of lack of information
Shivji, England (2015) [48]
Improving communication with primary care to ensure patient safety post-hospital discharge.
Interventional study, prospective review of electronic discharge summaries over a 6-week period, post-intervention review of discharge summaries, and a further review of discharge summaries was performed after 12 months (N = 180 electronic discharge summaries, 60 prospective, 60 post- intervention and 60 after 12 months). Improvement in discharge summaries and communication with primary care; increasing the content of discharge summaries. Risk of low quality
Risk of lack of education
Cresswell, England (2015) [49]
Mind the gap: Improving discharge communication between secondary and primary care.
Interventional study; electronic inpatient discharge documentation (eIDD); documentation of changes to medications and follow-up (N = 142). Implementation of interactive teaching sessions for first year doctors, design of an e-learning module, implementation of new electronic patient record system. Risk of lack of education
Risk of low quality
Ooi, Australia (2017) [32]
Improving communication of medication changes using a pharmacist-prepared discharge medication management summary.
Interventional study; retrospective audits of discharge summaries were conducted at baseline and after implementation of the Discharge Medication Management Summary (DMMS) (N = 573). Accuracy of medication change information communicated to GPs; GP satisfaction and feasibility of a pharmacist-prepared Discharge Medication Management Summary (DMMS). Risk of delay
Belleli, Australia (2013) [27]
Communication at the interface between hospitals and primary care: A general practice audit of hospital discharge summaries.
Retrospective study; audit of receipt rates, timeliness and the quality of discharge summaries for 49 admissions in an urban general practice (N = 49). Receipt rates, timeliness and the quality of discharge summaries. Risk of low quality Risk of lack of information
Wernick, New Zealand (2016) [64]
A randomised crossover trial of minimising medical terminology in secondary care correspondence in patients with chronic health conditions: Impact on understanding and patient reported outcomes.
Single-centre, non-blinded, randomised crossover study (N = 60 patients). Minimising the use of medical terminology in medical correspondence→ improved patient understanding and better anxiety/depression scores. Risk of low patient understanding
Heaton, England (2008) [44]
Undergraduate preparation for prescribing: The views of 2413 UK medical students and recent graduates.
Web-based survey; UK medical students and recent graduates about undergraduate training to prescribe and confidence about meeting the relevant competencies (students graduating in 2006–2008 from 25 UK medical schools) (N = 2413). To gather opinions from UK medical students and recent graduates about their undergraduate training to prescribe. Risk of lack of education
Choudry, USA (2015) [67] Readability of discharge summaries: With what level of information are we dismissing our patients? Scales [Flesch–Kincaid grade level (FKGL) and Flesch reading ease scores (FRES)] for evaluating readability of medical information (N = 497). Assessment of the health literacy of trauma discharge summaries. Risk of low patient understanding
Li, Australia (2013) [68] Timeliness in discharge summary dissemination is associated with patients’ clinical outcomes. Retrospective study on discharge summaries, (N = 16.496 patient admissions). Determination of the relation of readmission of general medical patients to either the existence of a discharge summary or the timeliness of its dispatch. Risk of delay
Horwitz, USA (2013) [22]Comprehensive quality of discharge summaries at an academic medical center. Prospective cohort study, patients discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia (N = 377). Timeliness of dictation, transmission of the summary to appropriate outpatient clinicians; conduction of a comprehensive quality assessment of discharge summaries. Risk of delay
Were, USA (2009) [18] Adequacy of hospital discharge summaries in documenting tests with pending results and outpatient follow-up providers. Retrospective study of a randomly selected sample, patients discharged from two large academic medical centers with pending test results (N = 696). To determine the adequacy with which hospital discharge summaries document tests with pending results and the appropriate follow-up providers. Risk of delay
Perren, Switzerland (2009) [33] Omitted and unjustified medications in the discharge summary. Prospective observational review of discharge summaries (N = 577). Evaluation the incidence and types of drug omissions and unjustified medications in the discharge summary; assessment of their potential impact on patient health. Risk of lack of information
Risk of low quality
Tong, Australia (2017) [38] Reducing medication errors in hospital discharge summaries: a randomised controlled trial. Unblinded, cluster randomised, controlled investigation of medication management plans for patients discharged after an inpatient stay in a general medical unit (Control group N = 431) (Intervention group N = 401). Reduction of the rate of medication errors through pharmacists completing medication management plans in the discharge summary. Risk of low quality
Greer, USA (2016) [26]
Hospital discharge communications during care transitions for patients with acute kidney injury: A cross-sectional study.
Cross-sectional review of inpatient hospital medical records (N = 75). To assess the presence and quality of hospital discharge communication about AKI (Acute Kidney Injury). Risk of low quality
Risk of lack of information
Gilmore-Bykovskyi, USA (2018) [19]
Hospital discharge documentation of a designated clinician for follow-up care and 30-day outcomes in hip fracture and stroke patients discharged to sub-acute care.
Retrospective cohort study (N = 1130). To assess the relationship between the omission of a responsible clinician/clinic for follow-up care from the hospital discharge summary and poor outcomes for patients transferred to sub-acute care. Risk of lack of information
Carlsson, Sweden (2012) [20]
Accuracy and continuity in discharge information for patients with eating difficulties after stroke.
Prospective, descriptive study (N = 15). Accuracy and continuity of discharge information for patients with eating difficulties after stroke. Risk of delay
Walz, USA (2011) [21]
Pending laboratory tests and the hospital discharge summary in patients discharged to sub-acute care.
Retrospective cohort study. Stroke, hip fracture, and cancer patients discharged from a single large academic medical center to sub-acute care, 2003–2005 (N = 564). To determine the prevalence and nature of lab tests pending at hospital discharge and their inclusion within hospital discharge summaries for common sub-acute care populations. Risk of delay
Polyzotis, Canada (2013) [14]
Primary care provider receipt of cardiac rehabilitation discharge summaries - are they getting what they want to promote long-term risk reduction?
Cross-sectional study,
PCPs (Primary Care Provider) who received a summary were mailed a survey assessing their perceptions of the summaries (N = 577).
To investigate receipt of Cardiac Rehabilitation (CR) discharge summaries by PCPs, as well as timing, and satisfaction with and perceptions of CR summaries. Risk of delay
Garcia, Norway (2017) [34]
Quality of medication information in discharge summaries from hospitals: an audit of electronic patient records.
Randomly selected discharge summaries, evaluation of the medication information (N = 60). To audit the quality of medication information in discharge summaries and explore factors associated with the quality. Risk of low quality
Monfort, France (2016) [35] Medication at discharge in an orthopaedic surgical ward: quality of information transmission and implementation of a medication reconciliation form. Prospective and retrospective study design (N = 30). To assess the completeness of medication information in the medical records, discrepancies between medications noted on the Best Possible Medication at Discharge List (BPMDL) and those prescribed on the discharge order, and the value of the BPMDL for stakeholders. Risk of lack of information