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Background Discharge summaries are essential to safe transitions from hospital to home. Objective To conduct a comprehensive quality assessment of discharge summaries. Design Prospective cohort study. Subjects 377 patients discharged home after hospitalization for acute coronary syndrome, heart failure or pneumonia. Measures Discharge summaries were assessed for timeliness of dictation, transmission of the summary to appropriate outpatient clinicians and presence of key content, including elements required by The Joint Commission and elements endorsed by six medical societies in the Transitions of Care Consensus Conference (TOCCC). Results A total of 376 of 377 patients had completed discharge summaries. A total of 174 (46.3%) summaries were dictated on the day of discharge; 93 (24.7%) were completed more than a week after discharge. A total of 144 (38.3%) discharge summaries were not sent to any outpatient physician. On average, summaries included 5.6 of 6 Joint Commission elements and 4.0 of 7 TOCCC elements. Summaries dictated by hospitalists were more likely to be timely and to include key content than summaries dictated by house staff or advanced practice nurses. Summaries dictated on the day of discharge were more likely to be sent to outside physicians and to include key content. No summary met all three quality criteria of timeliness, transmission and content. Conclusions Discharge summary quality is inadequate in many domains. This may explain why individual aspects of summary quality such as timeliness or content have not been associated with improved patient outcomes. However, improving discharge summary timeliness may also improve content and transmission.

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Purpose -The purpose of this paper is to review the epistemology of benchmarking and identify methodological elements of a theory of benchmarking. Design/methodology/approach -A thematic approach is applied to origins, primal and functional definitions of benchmarking. Findings -Benchmarking remains theoretically underdetermined, with publications focusing on pragmatism and praxis rather than epistemology. Analysis of the literature leads to a new definition of benchmarking focusing around the teleological processes that lead to state-transformation of organizations. Research limitations/implications -A theoretical foundation for benchmarking should be consistent with current organizational paradigms. Going forward the paper aims to develop a theory of benchmarking based on illustrative model derived from the thematic review. Practical implications -The paper initiates the development of a more rigorous theoretical base for future benchmarking practice, which will strengthen organizations' business cases for undertaking such processes. Originality/value -Recasts much of the extant literature in beginning to focus on the fundamentals of benchmarking.