Transition periods immediately following a hospitalization or higher level of care (HLOC) discharge are a highly vulnerable window for clients. Closing the clinical information gap quickly is vital for proactive risk management and continuity of care.
Why it matters
Securing this documentation immediately empowers providers to:
- Mitigate risk: Rapidly identify key care information such as medication changes, safety planning updates, and specific triggers that led to the hospitalization.
- Tailor interventions: Adjust your treatment plan to incorporate the acute care team's assessments and recommendations.
- Prevent Readmission: Ensure wrap-around support and continuity of care, reducing the likelihood of immediate relapse or readmission.
Provider expectations and timelines
At Rula, an engaged provider is usually the first one to know when a patient enters a higher level of care and when they discharge. As the client’s outpatient provider, you are best positioned to obtain the discharge record and after-care instructions to prevent any gaps in care.
- The Timeline: It is best practice to make an initial attempt to secure records within 48 hours of becoming aware of a patient discharge.
- The Reality: Because many factors can impact when you learn of a discharge, the golden rule is to attempt to obtain these records as promptly as possible once you are notified.
How to obtain discharge summaries
1. Engage the client directly
Clients are often sent home with physical or digital copies of their discharge summaries, medication lists, and after-care instructions. Asking the client to securely share these documents during or prior to your next session is often the fastest way to close the clinical information gap.
- Submission options: Clients can submit these documents by contacting Rula Support.
- In-session review: A client can also verbally read their discharge summary during a session, so you can review and discuss the clinical details together.
2. Contact the discharging facility
Navigating facility communication is much easier when you know your rights as a clinician under federal privacy laws.
Myth: A hospital or facility will only provide a discharge summary if I have a signed Release of Information (ROI).
Fact: Under the HIPAA Privacy Rule, healthcare providers are permitted to share Protected Health Information (PHI) to coordinate care for a shared client without a formal client authorization.
You may reach out directly to the discharging hospital's medical records or case management department, identify yourself as the client’s outpatient provider, and request the discharge summary for care coordination.
Note: While HIPAA permits the exchange of information with other healthcare providers for treatment purposes without an ROI, having an ROI on file fosters transparency with the client, protects their privacy, and ensures you are compliant with state-specific regulations that may be more stringent than federal HIPAA guidelines.
3. Utilize Rula's ROI process
While HIPAA legally allows provider-to-provider sharing, some facility policies still strictly require a signed Release of Information (ROI) before releasing records. If a facility requires an ROI, or you are coordinating with a non-covered entity, use the following workflow:
- Submit the form: Navigate to the Resources tab in the Rula provider portal. Under Documents and forms, select the Release of Information request form. For detailed instructions, refer to the Medical record requests and releases of information article in the Rula help center.
- Next steps: Rula’s Records team will email the client to obtain an electronic signature. Once completed, the signed ROI will be automatically uploaded to the Notes & Documents tab in the client's chart.
Documentation expectations
Whether your attempt to retrieve records is successful or you encounter barriers, it is best practice to document all care coordination efforts to support clinical risk management and compliance.
At Rula, collateral information and care coordination efforts are generally documented using a Blank Note. This includes provider-to-provider consultations, requests for information, and collateral information reviewed outside of a standard session.
Your Blank Note should capture the following elements:
- Who was involved: Name and role of the individual/facility contacted (e.g., "Jane Doe, Case Manager at General Hospital" or "Requested directly from client").
- Rationale for outreach: Why the contact was made (e.g., "Routine care coordination to obtain psychiatric discharge summary following inpatient stay from X to Y dates").
- Outcome/Summary: Did you receive the records? What were the key findings? (e.g., "Facility refused without Rula ROI; ROI requested via portal" OR "Summary received and reviewed. Client started on new SSRI; safety plan updated by hospital.")
- Treatment Plan impact: How this information alters or supports your current clinical approach.
Additional support
If you have made a good-faith initial attempt to retrieve these records but are encountering uncooperative facilities, facing complex risk-management concerns, or the client declines to sign an ROI, please reach out for additional support.
- Review our full guide on Medical record requests and releases of information.
- Contact the Rula Patient Programs team by submitting a request if you are facing complex risk mitigation concerns. The Clinical Quality team is also available to support you via regular consult groups or individual consults.
References
Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: A systematic review and meta-analysis. JAMA Psychiatry, 74(7), 694–702. https://pubmed.ncbi.nlm.nih.gov/28564699/
National Action Alliance for Suicide Prevention. (2019). Best practices in care transitions for individuals with suicide risk: Inpatient care to outpatient care. Substance Abuse and Mental Health Services Administration. https://theactionalliance.org/resource/best-practices-care-transitions-individuals-suicide-risk-inpatient-care-outpatient-care
Ojo, S., Okoye, T. O., Olaniyi, S. A., Ofochukwu, V. C., Obi, M. O., & Nwokolo, A. S. (2024). Ensuring continuity of care: Effective strategies for the post-hospitalization transition of psychiatric patients in a family medicine outpatient clinic. Cureus, 16(1), e52263. https://pubmed.ncbi.nlm.nih.gov/38352099/
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