An Evaluation of the Content of Pediatric Discharge Summaries

Abstract

OBJECTIVES: The need for high-quality discharge summaries is critical to ensure safe transitions of care. Deficits may lead to lapses in communication and poor outcomes. In this study, we sought to characterize the completeness, accuracy, and quality of pediatric discharge summaries. METHODS: A retrospective chart review of 200 discharge summaries of patients discharged from the general pediatrics service from July 2016 to October 2017 was conducted. These summaries were audited for 7 elements: admission date, discharge date, discharge diagnosis, medications, immunizations, pending laboratory tests, and follow-up appointments. Accuracy was verified through chart review. Quality of hospital course and patient instructions was evaluated by using a modified validated discharge summary evaluation tool. Additional data collected included medical complexity of the patient and the number of authors. Analysis of variance, χ2 tests, and Pearson correlations were used to analyze data. RESULTS: Discharge diagnosis, medications, and follow-up appointments had the lowest rates of completion and accuracy. The quality of the hospital course and patient instructions was variable, with no statistical significance seen in quality scores on the basis of the number of authors or medical complexity. There were more inaccuracies in discharge medications for patients with baseline chronic conditions than those without chronic conditions (63% vs 35%; P < .001). CONCLUSIONS: Content and quality of discharge summary documentation are inconsistent and have implications for patient outcomes after discharge. This study highlights areas of opportunity to improve pediatric discharge summaries. Future work should be focused on educational and systems-based interventions to improve documentation.

A Quality Improvement Approach to Improving Discharge Documentation

“…Investigators developed a hands-on educational session for house staff, which included: (1) a didactic portion on the history and importance of the transition of care communication/documentation; (2) presentation of local data obtained via a needs assessment 10 ; and (3) an interactive small-group workshop where trainees evaluated de-identified discharge summaries based on the standardized rubric and discussed specific feedback to improve quality. This session was delivered by three faculty members and one senior resident during a 1-hour protected conference time slot at the start of each training year.…”

“…The primary outcome measure was the percentage of selected discharge summaries in a 2-week period that contained all three required elements: discharge diagnosis, discharge medications, and follow-up appointments. The investigators chose these three elements after baseline data review 10 revealed the greatest opportunity to improve these essential elements of discharge summaries within the current EHR template. 8 As a balancing measure, investigators recorded delays in discharge summary completion: the number of discharge summaries that house staff completed after the date of discharge.…”

“…9 Despite these criteria, there is a wide variation in discharge summary content, and many do not meet these basic standards. [10][11][12][13][14][15] A local needs assessment demonstrated deficiencies in the inclusion of three required elements: discharge diagnosis, discharge medications, and follow-up appointments. 10 Deficits in these elements have been shown to lead to poor patient outcomes and increased healthcare costs.…”

“…[10][11][12][13][14][15] A local needs assessment demonstrated deficiencies in the inclusion of three required elements: discharge diagnosis, discharge medications, and follow-up appointments. 10 Deficits in these elements have been shown to lead to poor patient outcomes and increased healthcare costs. Lack of diagnosis clarity contributes to low health literacy, leading to higher emergency room use.…”

Development and Pilot Implementation of a Patient Oriented Discharge Summary for Critically Ill Patients (PODS-ICU)

“…21,22 Most patient-and caregiver-centered discharge summary tools use evidence-based techniques such as plain language, large fonts, 23 pictograms, 24 and teach-back components 25,26 to ensure patients are engaged and develop a strong understanding of their health. 27 While written patient-centered discharge tools have become commonplace in surgical, 28 rehabilitation, 29 and pediatric settings, 30 few have been employed in critical care settings. 31 To address the need for a standardized, written, patient-centered discharge tool suitable for use in the ICU, our team of patient partners (i.e., previous patients and family-caregivers who now represent patients' interest in research), clinicians, and researchers aimed to incorporate ICU-speci c elements into the Patient Oriented Discharge Summary (PODS) tool co-developed by patients, the Toronto Central Local Health Integration Network, and OpenLab (Toronto, Canada).…”