SNF Discharge Summaries: Chief of Geriatrics and Transitional Care Offers Reflections on Use and Impact

March 9, 2018 | Aging Services Risk Management


​Upon review of a skilled-nursing facility's (SNF) discharge summary “journey," one chief of geriatrics and transitional care emphasizes the importance of facility-wide coordination of the discharge process, accurate information, and timely transmittal, as stated in an article published in the February 2018 issue of Caring for the Ages. In October 2017, Wayne Saltsman, MD, PhD, CMD, sought to better understand how valuable his discharge summaries were to primary care providers (PCPs), how the summaries reach PCPs, and how summaries are used to inform future care. His efforts included meeting with a PCP whose patients he had also cared for and soliciting the PCP's feedback as a receiver of his discharge summaries. Through this collaboration, the author concluded that all his summaries were in fact reaching the appropriate PCP. However, based on the PCP's feedback, the author also concluded that the summaries were difficult to read after faxing and scanning records; that PCPs typically prefer concise, typed notes versus handwritten, lengthy summaries; and the author found discrepancies between the hierarchy of information presented in discharge summary templates and the information that receiving PCPs prefer to see first. According to the Centers for Medicare and Medicaid Services' Requirements of Participation for SNFs, a discharge summary must include a “recapitulation of the resident's stay, final summary of the resident's status, reconciliation of medications, and post-discharge plan of care." The article cites best practices that suggests discharge instructions be transmitted to the PCP at the time of discharge and the formal discharge summary be transmitted within 72 hours or before the first post-SNF visit (whichever comes first).

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