Discharge summaries from cardiac rehab often fail to reach primary care clinicians in Canada, study finds

Primary care clinicians often don't receive their patients' discharge summaries from cardiac rehabilitation, according to a new study.

Researchers performed an observational, cross-sectional study to determine how often and when primary care clinicians received cardiac rehab discharge summaries, as well as their perception of and satisfaction with them. Between September 2008 and March 2011, consecutive enrollees at eight cardiac rehab programs in Toronto, Canada, were asked to give their consent to participate in the study and to provide the names of their primary care clinicians. Clinicians were mailed an information letter and a consent form and were in turn asked to participate. The researchers tracked the progress of discharge summaries to the clinicians' offices, and those who received discharge summaries were sent a survey asking them to rate their satisfaction on a five-point Likert scale. The study results were published online Jan. 8 by Circulation: Cardiovascular Quality and Outcomes.

Of the 577 clinicians invited to participate, 138 (24.0%) accepted. A total of 71 clinicians (51.5%) received cardiac rehab discharge summaries, and of these 64 (90.1%) completed the survey. All of the clinicians in the study said they wanted to receive discharge summaries, preferably (61.3%) by fax. Forty-seven (77.1%) reported they had used or planned to use information from the discharge summary in patient care, but those who didn't receive the summary before a patient's first post-rehab visit (n=7) were significantly less likely to ever use it (P<0.01). The researchers used a five-point Likert scale to assess the items considered most important to include in a discharge summary and found that PCPs most valued information on medication (4.65±0.74), patient care plan (4.43±0.87), and clinical status (4.33±0.94). However, 18.8%, 4.7%, and 22.2% of summaries, respectively, did not provide this information.

The study authors acknowledged that the clinician response rate was low, that the generalizability of the results was not known, and that the cardiac rehab sites were aware of the study objectives, among other limitations. However, they concluded that a large percentage of primary care clinicians do not receive their patients' discharge summaries after cardiac rehab and that this discrepancy reveals “a large gap in continuity of patient care.” The results of their study suggest “that more standardized strategies for [cardiac rehab] summary information gathering, generation, and transmission are required,” they wrote.