Tying up loose ends: discharging patients with unresolved medical issues.
Hospitalized patients are frequently discharged with test results or diagnostic workups pending, with the intention that these will be followed up by outpatient physicians. However, a recent systematic review found that communication between inpatient and outpatient physicians is suboptimal, with primary care physicians frequently being unaware of patients' discharge needs. This study reviewed discharges from the medical service at an academic hospital to determine how often outpatient workups were recommended and completed. More than one-third of recommended outpatient investigations were not completed, frequently because the discharge summary did not contain details of the necessary workup, or because the discharge summary was not available at the time of the patient's clinic visit. Recognition of this problem has led to the development of formal discharge checklists to ensure optimal communication at the time of hospital discharge.