Journal of General Internal Medicine

, Volume 24, Issue 9, pp 1002–1006 | Cite as

Adequacy of Hospital Discharge Summaries in Documenting Tests with Pending Results and Outpatient Follow-up Providers

  • Martin C. Were
  • Xiaochun Li
  • Joe Kesterson
  • Jason Cadwallader
  • Chite Asirwa
  • Babar Khan
  • Marc B. Rosenman
Hospital Medicine



Poor communication of tests whose results are pending at hospital discharge can lead to medical errors.


To determine the adequacy with which hospital discharge summaries document tests with pending results and the appropriate follow-up providers.


Retrospective study of a randomly selected sample


Six hundred ninety-six patients discharged from two large academic medical centers, who had test results identified as pending at discharge through queries of electronic medical records.


Each patient’s discharge summary was reviewed to identify whether information about pending tests and follow-up providers was mentioned. Factors associated with documentation were explored using clustered multivariable regression models.


Discharge summaries were available for 99.2% of 668 patients whose data were analyzed. These summaries mentioned only 16% of tests with pending results (482 of 2,927). Even though all study patients had tests with pending results, only 25% of discharge summaries mentioned any pending tests, with 13% documenting all pending tests. The documentation rate for pending tests was not associated with level of experience of the provider preparing the summary, patient’s age or race, length of hospitalization, or duration it took for results to return. Follow-up providers’ information was documented in 67% of summaries.


Discharge summaries are grossly inadequate at documenting both tests with pending results and the appropriate follow-up providers.


tests with pending results continuity of care patient safety discharge summary medical errors 



This work was performed at Regenstrief Institute and Indiana University School of Medicine, Indianapolis, IN, and was supported by grant LM07117-11 from NLM and KL2RR025760-01 from NCRR. The authors appreciate the support of Drs. Marc Overhage, William M. Tierney and IUSM EIP-REACH.

Conflict of interest



  1. 1.
    Roy CL, Poon EG, Karson AS, et al. Patient safety concerns arising from test results that return after hospital discharge. Ann Intern Med. 2005;143(2):121–8.PubMedGoogle Scholar
  2. 2.
    Solet DJ, Norvell JM, Rutan GH, Frankel RM. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med. 2005;80(12):1094–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161–7.PubMedGoogle Scholar
  4. 4.
    Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Hamilton JD. Quality in Australian health care study. Med J Aust. 1996;164(12):754.PubMedGoogle Scholar
  5. 5.
    Kosecoff J, Kahn KL, Rogers WH, et al. Prospective payment system and impairment at discharge. The ‘quicker-and-sicker’ story revisited. JAMA. 1990;264(15):1980–3.PubMedCrossRefGoogle Scholar
  6. 6.
    McMahon LF Jr. The hospitalist movement-time to move on. N Engl J Med. 2007;357(25):2627–9.PubMedCrossRefGoogle Scholar
  7. 7.
    van Walraven C, Seth R, Austin PC, Laupacis A. Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med. 2002;17(3):186–92.PubMedCrossRefGoogle Scholar
  8. 8.
    IM.6.10. S. Hospital Accreditation Standards: Joint Commission Resources. Oakbrook Terrace, IL; 2006.Google Scholar
  9. 9.
    Halasyamani L, Kripalani S, Coleman E, et al. Transition of care for hospitalized elderly patients-development of a discharge checklist for hospitalists. J Hosp Med. 2006;1(6):354–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Wilson S, Ruscoe W, Chapman M, Miller R. General practitioner-hospital communications: a review of discharge summaries. J Qual Clin Pract. 2001;21(4):104–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Foster DS, Paterson C, Fairfield G. Evaluation of immediate discharge documents-room for improvement? Scott Med J. 2002;47(4):77–9.PubMedGoogle Scholar
  12. 12.
    Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18(8):646–51.PubMedCrossRefGoogle Scholar
  13. 13.
    McDonald CJ, Overhage JM, Barnes M, et al. The Indiana network for patient care: a working local health information infrastructure. An example of a working infrastructure collaboration that links data from five health systems and hundreds of millions of entries. Health Aff (Millwood). 2005;24(5):1214–20.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Martin C. Were
    • 1
    • 2
  • Xiaochun Li
    • 1
    • 2
  • Joe Kesterson
    • 2
  • Jason Cadwallader
    • 1
  • Chite Asirwa
    • 1
  • Babar Khan
    • 1
  • Marc B. Rosenman
    • 1
    • 2
  1. 1.Indiana University School of MedicineIndianapolisUSA
  2. 2.Regenstrief Institute, Inc.IndianapolisUSA

Personalised recommendations