Abstract
BackgroundPatients undergoing orthopaedic procedures experience major changes in function and daily routines upon their return home. Discharge summaries are an important communication tool that may play a role in optimizing a safe transition from hospital. Current care gaps and key elements of an ideal discharge summary specific for orthopaedic population are unknown. We sought to identify the challenges of current orthopaedic discharge summaries and to determine key elements of an ideal document.MethodsQualitative study survey using semi-structured interviews with a sample of 17 patients and clinicians representing diverse professions, backgrounds, and practice settings. We used the constant comparative method of qualitative analysis to define the experiences and perceptions of quality gaps and strategies to improve orthopaedic-specific discharge summaries.ResultsWe identified 3 major themes describing factors perceived to be limiting the quality of current discharge summaries: 1) physician-centric documentation and the absence of a comprehensive, inter-professional perspective; 2) access to resources and health informatics; and 3) process variations in document creation and dissemination.ConclusionsClinicians and patients identified several factors limiting the quality of discharge summaries among orthopaedic inpatients. Incorporating these elements could improve hospital transitions.
Highlights
Patients undergoing orthopaedic procedures experience major changes in function and daily routines upon their return home
Our findings revealed a number of common themes among participants, all of whom have had a range of experience with the current orthopaedic discharge summary in their various roles in the hospital and rehabilitation setting (Table 2)
Challenge of current of discharge summary Three major themes emerged from the interviews describing current challenges to producing high quality discharge summaries for orthopaedic inpatients
Summary
Patients undergoing orthopaedic procedures experience major changes in function and daily routines upon their return home. There is an increase in the volume of patients discharged to post-acute care as a solution for those who no longer require high intensity care but are unprepared for home [1]. Patients returning home or discharged to post-acute care facilities are exposed to preventable harm, often as a result of suboptimal transitions of care. While poor transitions have been extensively studied for patients returning home, little is known of the quality of inter-facility transitions and the new problems that may arise as a result. What is known, is that patients experiencing multiple transitions across the continuum of care are at risk of preventable harm due to suboptimal communication. High quality discharge summaries play an important role in transferring critical information between providers and may reduce adverse events (such as avoidable readmission) in the post-discharge period [5]. Details on activity instructions, therapy orders, and pending studies are frequently missing from discharge summaries created for patients transferred to rehabilitation facilities [6]
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