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Pending Laboratory Tests and the Hospital Discharge Summary in Patients Discharged To Sub-Acute Care

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Previous studies have noted a high (41%) prevalence and poor discharge summary communication of pending laboratory (lab) tests at the time of hospital discharge for general medical patients. However, the prevalence and communication of pending labs within a high-risk population, specifically those patients discharged to sub-acute care (i.e., skilled nursing, rehabilitation, long-term care), remains unknown.

Objective

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.

Design

Retrospective cohort study.

Participants

Stroke, hip fracture, and cancer patients discharged from a single large academic medical center to sub-acute care, 2003–2005 (N = 564)

Main Measures

Pending lab tests were abstracted from the laboratory information system (LIS) and from each patient’s discharge summary, then grouped into 14 categories and compared. Microbiology tests were sub-divided by culture type and number of days pending prior to discharge.

Key Results

Of sub-acute care patients, 32% (181/564) were discharged with pending lab tests per the LIS; however, only 11% (20/181) of discharge summaries documented these. Patients most often left the hospital with pending microbiology tests (83% [150/181]), particularly blood and urine cultures, and reference lab tests (17% [30/181]). However, 82% (61/74) of patients’ pending urine cultures did not have 24-hour preliminary results, and 19% (13/70) of patients’ pending blood cultures did not have 48-hour preliminary results available at the time of hospital discharge.

Conclusions

Approximately one-third of the sub-acute care patients in this study had labs pending at discharge, but few were documented within hospital discharge summaries. Even after considering the availability of preliminary microbiology results, these omissions remain common. Future studies should focus on improving the communication of pending lab tests at discharge and evaluating the impact that this improved communication has on patient outcomes.

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Acknowledgments

The authors would like to acknowledge the contributions of key people who helped make this project a success: Patty Horstmeier, Donald Wiebe, Wen-Jan Tuan, Patrick Ferguson and Peggy Munson.

Funding for this project was provided by the University of Wisconsin (UW) Hartford Center of Excellence in Geriatrics and the UW Health Innovation Program. Dr. Kind is supported by a K-L2 through the NIH grant 1KL2RR025012-01 [Institutional Clinical and Translational Science Award (UW-Madison) 1UL1RR025011 (KL2) program of the National Center for Research Resources, National Institute of Health]. Additional support was provided by the Health Innovation Program and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), grant 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources, National Institutes of Health. The project described was supported by Award Number K23AG034551 from the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.

We presented an earlier version of the manuscript as a poster at the American Geriatrics Society Annual Meeting in Orlando, Florida, in May 2010.

Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Population Health Sciences, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA

    Stacy E. Walz MS, Maureen Smith MD, MPH, PhD & Amy J. H. Kind MD

  2. Department of Family Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA

    Maureen Smith MD, MPH, PhD

  3. Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA

    Maureen Smith MD, MPH, PhD

  4. Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA

    Elizabeth Cox MD, PhD

  5. Department of Neurology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA

    Justin Sattin MD

  6. Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Amy J. H. Kind MD

  7. United States Department of Veterans Affairs, William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center (GRECC), Madison, WI, USA

    Amy J. H. Kind MD

Authors
  1. Stacy E. Walz MS
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  2. Maureen Smith MD, MPH, PhD
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  3. Elizabeth Cox MD, PhD
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  4. Justin Sattin MD
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  5. Amy J. H. Kind MD
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Corresponding author

Correspondence to Stacy E. Walz MS.

Appendix

Appendix

Table 4 shows categories and representative examples of laboratory tests

Table 4 Categories and Representative Examples of Laboratory Tests16
Full size table

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Walz, S.E., Smith, M., Cox, E. et al. Pending Laboratory Tests and the Hospital Discharge Summary in Patients Discharged To Sub-Acute Care. J GEN INTERN MED 26, 393–398 (2011). https://doi.org/10.1007/s11606-010-1583-7

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  • DOI: https://doi.org/10.1007/s11606-010-1583-7

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