Assessing Origins of Quality Gaps in Discharge Summaries: A Survey of Resident Physician Attitudes

Abstract

Because little is known about attitudes of primary authors of discharge summaries in academic institutions, namely trainees and physician assistants (PAs), we sought to explore values, possible areas for improvement, and interest in formal discharge summary education. A survey composed of Likert scale analyses, dichotomous relationships, and open-ended questions was designed using focus groups and validated via expert committee review. Of 135 total residents (PGY 1-3), 79 residents and 10 PAs in a large academic hospital in New York City completed it. Of surveyed trainees, 77.2% reported that quality discharge summaries are useful in primary care. Interns had less outpatient experience with discharge summaries compared to PGY 2&3s (23.7% vs. 63.4%, p< 0.001) and were less comfortable authoring discharge summaries for patients who were not as familiar to them (47.4% vs. 24.4%, p=0.04). The majority (54.8%) of interns as well as all PAs reported never receiving feedback on discharge summaries. Finally, 63.2% of interns and 90% of PAs responded that formal teaching would be helpful. Interns' greater discomfort may speak to their poor understanding of core components of a useful discharge summary, which teaching sessions may improve. Alternatively, shifting the authorship responsibility from interns to seniors could be explored as a quality improvement initiative.

Improving the quality of inpatient discharge summaries

“…The junior doctor education around appropriate documentation of investigations, such as the inclusion of relevant information that was appropriately summarized, was successful. This showed that continued education can produce sustained results [8,9], which is consistent with findings from our background research.…”

Residents' Exposure to Educational Experiences in Facilitating Hospital Discharges

“…Discharge summaries are an ideal starting place, as the literature provides several examples of how to teach and evaluate residents' discharge summaries. [24][25][26] Similar to other studies, 16,27 our results suggest that formal discharge summary review is underutilized, despite evidence of its efficacy. Conducting discharge summary reviews is an excellent starting point for programs seeking to build transitions of care curricula rooted in competency-based education.…”

Improving the quality of discharge summaries through a direct feedback system

“…Previous studies have shown that junior clinicians feel that specific training in discharge documentation would be of benefit. 16 Therefore, there have been numerous previous attempts to carry out projects that aim to improve the quality of discharge summaries. 17,18 Techniques employed have ranged from the provision of one-off and regular teaching sessions to clinicians through to programmes providing both teaching and feedback.…”