Experience of medical senior house officers in preparing discharge summaries

Frain, J. P. J.; Frain, A.; Carr, P. H.

doi:10.1097/00042737-199603000-00028

Cited by 4 publications

(4 citation statements)

References 1 publication

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“…This study demonstrates that a programmatic change that reduces workload can improve processes of care, as measured by discharge summary quality. Residents consistently report that high-quality summaries are time consuming and report a conflict between quality and exigency 12,19 . Few studies have directly addressed the discharge summary and communication with PCPs in the context of the typical residents' workload.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Workload Reduction on the Quality of Residents’ Discharge Summaries

2010

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BACKGROUND:The completeness of hospital discharge summaries may reflect the overall quality of interprofessional communications. The effect of reducing resident workload on clinical performance is largely unknown. OBJECTIVE: We examined the impact of reducing housestaff workload on the quality of discharge summaries, an indicator of clinical performance, as compared to discharge summaries created by trainees on a team with a more typical workload. DESIGN: Patients admitted to a medicine service at a community teaching hospital affiliated with an academic medical center were alternately allocated between a control and intervention care team of residents. Firstyear residents on the intervention team carried an average census of 3.5 patients compared with 6.6 patients for peers on the control team. A random selection of 142 discharge summaries from a 3-month period were blindly evaluated using a structured tool based on professional documentation standards. PARTICIPANTS: 61 internal medicine residents. MAIN RESULTS: Inter-rater reliability of discharge summary quality was 0.9. Discharge summaries produced by residents on the intervention team with a reduced workload had significantly more of the required elements (74 vs 65%, p<0.001). Intervention team summaries were more frequently complete and contained significantly more of the required elements describing the patient history (65.7% vs 36.1%, p =0.0005), the inpatient narrative (47.1% vs 22.2%, p =0.003), discharge planning (20.0% vs 5.5%, p= 0.012), and continuity of care (24.3% vs 6.9%, p = 0.005). Fewer than a quarter of the summaries reviewed included discharge instructions, information on follow-up care, or a discharge medication list. CONCLUSIONS: Reducing resident workload can significantly improve discharge summary quality, a measure of resident performance.KEY WORDS: discharge summary; residency design; work hours.

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Section: Discussionmentioning

confidence: 99%

The Effect of Workload Reduction on the Quality of Residents’ Discharge Summaries

2010

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“…Overall, an unambiguous relationship between diagnoses and medications should be warranted. Although not proven, it seems conceivable that better instruction might lead to more reliable DSs: one survey reported the almost complete lack of guidance given to junior doctors in preparing them 19. The implementation of a prescribed dictation template has been shown to result in better and shorter DSs 20 21.…”

Section: Commentmentioning

confidence: 99%

Omitted and unjustified medications in the discharge summary

Perren

Previsdomini

Cerutti³

et al. 2009

Quality and Safety in Health Care

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BACKGROUND: Limited information exists in regard to drug omissions and unjustified medications in the hospital discharge summary (DS). OBJECTIVE: To evaluate the incidence and types of drug omissions and unjustified medications in the DS, and to assess their potential impact on patient health. METHODS: A prospective observational review of the DSs of all patients discharged from our Internal Medicine Department over a 3-month period. Data assessment was made by internists using a structured form. RESULTS: Of the 577 evaluated DSs, 66% contained at least one inconsistency accounting for a total of 1012 irregularities. There were 393 drug omissions affecting 251 patients, 32% of which were potentially harmful. Seventeen per cent of all medications (619/3691) were unjustified, affecting 318 patients. The unjustified medication was potentially harmful in 16% of cases, occurred significantly more frequent in women than in men (61% vs 50%; p = 0.008) and increased linearly with the number of drugs prescribed (p<0.001). Drug omission had a twofold higher potential to cause harm than unjustified medication. CONCLUSIONS: Drug omissions and unjustified medications are frequent, and systemic changes are required to substantially reduce these inconsistencies.

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“…9 Postgraduate training is often the first opportunity for physicians to learn information transfer management skills. Unfortunately, DS are created by house staff who have minimal training in this area 11 and feel like they have to learn ''by osmosis'', 12 resulting in poor quality DS and lack of availability at the point of care. [13][14][15] Previous research suggested that individualized feedback sessions for Internal Medicine residents improved the quality of certain aspects of their completed DS.…”

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confidence: 99%

Audit and feedback: An intervention to improve discharge summary completion

Dinescu

Fernandez

Ross

et al. 2011

Journal of Hospital Medicine

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Discharge summaries (DS) communicate important clinical information from inpatient to outpatient settings. Previous studies noted increased adverse events and rehospitalization due to poor DS quality. We postulated that an audit and feedback intervention of DS completed by geriatric medicine fellows would improve the completeness of their summaries. We conducted a preintervention post intervention study. In phase 1 (AUDIT #1 and FEEDBACK) we scored all DS (n ¼ 89) completed by first year fellows between July 2006 to December 2006 using a 21-item checklist. Individual performance scores were reviewed with each fellow in 30-minute feedback sessions. In phase 2 (AUDIT #2) we scored all DS (n ¼ 79) completed after the first phase between February 2007 to July 2007 using the same checklist. Data were analyzed using generalized estimating equations. Fellows were more likely to complete all required DS data after feedback when compared with prior to feedback (91% vs. 71%, P < 0.001). Feedback was also associated with improved admission (93% vs. 70%, P < 0.001), duration of hospitalization (93% vs 78%, P < 0.001), discharge planning (93% vs. 18%, P < 0.02) and postdischarge care (83% vs. 57%., P < 0.001) section-specific information. In conclusion, audit and feedback sessions were associated with better DS completeness in areas of particular importance to geriatric care.

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Experience of medical senior house officers in preparing discharge summaries

Cited by 4 publications

References 1 publication

The Effect of Workload Reduction on the Quality of Residents’ Discharge Summaries

The Effect of Workload Reduction on the Quality of Residents’ Discharge Summaries

Omitted and unjustified medications in the discharge summary

Audit and feedback: An intervention to improve discharge summary completion

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