Hospital Discharge Orders Often Not Seen

If you or someone you love has a hospital stay coming up, make absolutely certain that you request to see discharge orders when the time comes to go home. That's because healthcare personnel may never look at them or they may never tell you what the doctor wants you to do in terms of follow up care.

An article published in the Archives of Internal Medicine reports that a study done at the University of New South Wales in Sydney, Australia showed that although tests requested on the day of discharge represented only 6.8% of all tests performed, they "contributed disproportionately to the total number of tests that were not followed up, accounting for 46.8% of all missed results . . . Not all test results were available at discharge, with 28.6% of tests still pending. At discharge, 21.3% of tests ordered on that day were not followed up compared with 1.8% of tests ordered on other days."  

Lead author Mei-Sing Ong, PhD of the Australian Institute for Health Innovations and his team point out that hospital discharge is "a critical transition point for many patients, with 1 in 5 patients experiencing an adverse event in the transition from hospital to home and with 62% of these adverse events being preventable. Failure to follow up test results after discharge contributes to this risk."

The researchers recommend "improvement strategies" such as clearly communicating to all members of a clinical team that discharge is being planned and instituting team rules on appropriate testing and review procedures late in admission. "Discharge protocols should require review of pending or unreviewed test results," they wrote. "When discharge dates are known, or the average length of stay for an admission is well defined, the time available for review can be estimated and used to trigger computer alerts when tests are being ordered electronically. Alerts could advise clinicians either that it is unlikely that results will be posted before discharge or that the tests simply have a high risk of being missed." However, remember that you have a right to your own medical records and that there is no need to leave the discharge planning up to anyone other than you and your personal advocate, such as a family member or friend. Be proactive and get those discharge orders yourself!  
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