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.

Intensity of hospital services is often estimated by length of stay (LOS). Increasing demands for documentation in the medical record suggested to us an alternate method: weighing the chart. In a retrospective study, we compared LOS and chart weight as predictors of actual hospital costs at a community teaching hospital. We reviewed a sample of 123 patients randomly chosen from the medical service and stratified by phase of the academic year. Both least-squares regression and a multiple sampling/validating technique were used to derive mean cost per ounce of chart and per day of stay. Costs estimated from weight were within 7% and from LOS within 14% of measured actual costs among patients not used to derive the formulae. We conclude that the intensity of paper documentation closely reflects actual costs; the same may be true of bytes or key-strokes for electronic records.