Communication gaps and readmissions to hospital for patients aged 75 years and older: observational study

Objectives: (1) To identify communication gaps at hospital discharge for older people who are readmitted within 28 days; (2) to assess the contribution of incomplete discharge information to readmission; (3) to identify measures that might improve communication at hospital discharge. Design: Retrospective case-note review. Setting: A teaching hospital in Nottingham, UK. Sample: 108 consecutive patients aged 75 and over who were readmitted as an emergency within 28 days of previous discharge. Main outcome measures: (1) Proportion of patients discharged with insufficient arrangements and/or information for immediate safe continuity of care; (2) proportion of patients with medication management information missing; (3) proportion of readmissions related to incomplete medication management information and proportion of patients for whom this was preventable. Results: Thirty patients (28%) returned within 3 days of discharge, 48 (44%) within 7 days and the remainder within 28 days. Sixty-seven (62%) patients either had no discharge letter or returned before the letter was typed. Documentation of changes in medication was incomplete on two-thirds of all discharge documents. Readmission was considered to be related to medication for 41 (38%) patients and to be preventable for 25 (61%) of these. There were preventable discharge communication gaps, including monitoring information, for 22 (54%) of these patients. Conclusion: Incomplete documentation at discharge was common, particularly for medication management. It is likely that communication gaps contributed to many of the preventable adverse events and readmissions.