A Quality Improvement Initiative to Improve Discharge Timeliness and Documentation

Abstract

Introduction: Discharge communication is critical for the continuity of patient care. However, discharge summaries are often not available in time for follow-up visits, and the content is inconsistent. We aimed to decrease the average time to discharge summary completion by 25%, reduce deficiencies (information errors) by 50%, and increase discharge summary template use to >80% in 6 months. Methods: A pediatric interprofessional team used quality improvement methods to identify barriers and implement interventions, including discharge summary completion time expectation, electronic health record discharge summary template changes addressing gaps, and training. Notable changes to the template included embedded writing tips to guide writers and specific template choices for common diagnoses to standardize content. The primary outcome measure was the mean discharge summary completion time. Secondary measures were the percentage of discharge summaries with deficiencies and the rate of template use. Results: After interventions, the mean discharge summary completion time decreased by 70% (from 71.5 to 21.8 hours). Discharge summary deficiencies decreased 44% (from 4.5% to 2.5%), and template use increased from 62% to 97%. Conclusion: Quality improvement methods and a newly designed electronic health record-discharge summary template were used to dramatically improve discharge summary timeliness and standardize content to streamline continuity of care.

Design and implementation of an electronic opioid management plan to support consistent communication of opioid analgesia prescribing intentions to patients and general practitioners

“…Improvement strategies could include: setting clear expectations for when discharge summaries must be completed, discharge summary template redesign to automate inclusion of the discharge prescription list and OMP, and protected time for medical staff to complete discharge summaries. 14,15 Initial OMP implementation in orthopaedic units informed improvements to implementation for other surgical units. Whilst poor medical staff engagement with passive hospital education activities may have been heightened following COVID-19 pandemic pressures, these approaches have also had limited effectiveness at other times.…”

“…Our hospital is currently reviewing our discharge summary template and workflow to improve the timeliness and quality of discharge documentation for GPs. Improvement strategies could include: setting clear expectations for when discharge summaries must be completed, discharge summary template redesign to automate inclusion of the discharge prescription list and OMP, and protected time for medical staff to complete discharge summaries 14,15 …”

Disappearing Help Text: Implementing a Note-Based Tool for In-Line Clinical Decision Support and Note Bloat Reduction

“…Notably, we did not see a reduction in character count in discharge summaries even as the usage of laboratory Smar-tLinks was reduced by half. This is likely due to a concomitant change in our Discharge Summary template that added a "Suggested Next Steps for Primary Care Provider" section, 14 which highlighted significant follow-up needs and would be considered relevant note information rather than note bloat.…”

Data Quality–Driven Improvement in Health Care: Systematic Literature Review

“…For uniqueness, studies assessed if records were unexpectedly duplicated, for example in primary keys [78] or patient names [94]. Likewise, timeliness was consistently assessed as the difference in time between point of data capture versus actual timing of events [73,74,76,80,81,103]. In contrast, some of the DQ concepts reported could not be classified according to the DAMA DQ framework, including simplicity, acceptability, flexibility, stability, usefulness [76], and conformance to a specified data model [89].…”

“…Twenty studies reported using quantitative or qualitative data analysis before planning an intervention. Qualitative analysis involved assessment of clinical workflow inefficiencies through process mapping techniques or staff surveys [73,107]. In contrast, quantitative analysis involved an assessment of DQ with interpretations of possible root causes [94,95].…”