Nurses report significant gaps in communication among patients discharged from the hospital with home healthcare (HHC) services. The aim of this pilot study was to quantify the contents of HHC admission packets used to guide nurses' first home visit after hospital discharge. We evaluated 20 randomly selected charts of older adults admitted to HHC after a hospitalization for heart failure. Admission packets contained nearly 50 pages of material, which frequently included duplicate documents printed from the hospital-based electronic health record (EHR). Despite the plethora of documents, most packets omitted key information, such as patients' cognitive and functional status, and even discharge summaries, which would be relevant and actionable for HHC nurses. Moreover, admission packets contained multiple, often discordant, EHR-generated medication lists, which makes reconciliation challenging for nurses and puts vulnerable patients at risk for adverse drug events. Overall, there is an urgent need to improve health information exchange between hospitals and HHC agencies, which will simultaneously promote nurse efficiency and patient safety.
Erin Sarzynski, MD, MS, is an Assistant Professor, Department of Family Medicine and Institute for Health Policy, College of Human Medicine, Michigan State University, East Lansing, Michigan.
Mark Ensberg, MD, is an Associate Professor, Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, and Medical Director, Sparrow Home Care, Sparrow Health System, Lansing, Michigan.
Amy Parkinson, RN, BSN, MS, is Director, Sparrow Home Care, Sparrow Health System, Lansing, Michigan.
Keren Shahar, MD, is Chief Resident, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan.
Kevin Brooks, PhD, is an Academic Specialist, College of Human Medicine, Institute for Health Policy, Michigan State University, East Lansing, Michigan.
Charles Given, PhD, is a Professor Emeritus, Michigan State University, East Lansing, Michigan.
The authors thank Kathleen Oberst, PhD, RN, for her critical review of the manuscript.
Financial Disclosure: This work was supported by the Michigan Department of Health and Human Services Contract #20170255 (HIT Resource Center) and Michigan State University Institute for Health Policy.
Author Contributions: Sarzynski, Ensberg, Parkinson, Brooks, and Given: study concept and design. All authors: acquisition of data. Sarzynski, Ensberg, Brooks, and Given: analysis and interpretation of data. Sarzynski: drafting of manuscript. All authors: critical revision, approval of paper for publication.
Sponsor's Role: The sponsor had no role in the study concept or design, methods, data collection, analysis, or preparation of this paper.
Conflict of Interest: ES reports income from the Center for Medical Education for her role as a commentator in Continuing Medical Education (CME) audio publications. The remaining listed authors have no conflicts of interest to declare.
Address for correspondence: Erin Sarzynski, MD, MS, College of Human Medicine, Institute for Health Policy, Michigan State University, 965 Fee Road, Room A133, East Lansing, MI 48824 (firstname.lastname@example.org).