Discharge summaries are intended to transfer important clinical information from inpatient to outpatient settings and between hospital admissions. The authors created a point scale that rated summaries in 4 key areas and applied the scale at a community teaching hospital over 3 years. Charts of 150 patients were selected equally from those discharged early and late in the academic year. Residents dictated all summaries after July 2003 using a prominently displayed template. Two residents and a senior physician assessed dictation quality. Considerable differences were found among raters, particularly in the evaluation of style. The average of the 3 raters' scores improved 21%, and dictation length decreased 67% after introduction of the template (P < .001). No relationship was found among service intensity (measured as chart weight), dictation length (measured in lines), and quality. Measured by a comprehensive rating scale, the quality of discharge summaries increased with use of a template while their length decreased.

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Increased weekend continuity of care is associated with reduced length of stay. Improvement in weekend cross-coverage and patient handoffs may be useful to improve clinical outcomes.

The effect of care by medical residents on hospital length of stay (LOS), indirect costs, and reimbursement was last examined across a range of illnesses in 1981; the issue has never been examined at a community hospital. We studied resource utilization and reimbursement at a community hospital in relation to the involvement of medical residents.DESIGN: This nonrandomized observational study compared patients discharged from a general medicine teaching unit with those discharged from nonteaching general medical/ surgical units.SETTING: A 620-bed community teaching hospital with a general medicine teaching unit (resident care) and several general medicine nonteaching units (no resident care).

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