Electronic Discharge Summaries Research Articles

Review of electronic discharge summaries from the general medicine, general surgery and mental health streams at a tertiary hospital: retrospective analysis of timeliness, brevity and completeness.

Objective This retrospective study identified and compared the performance of electronic discharge summaries (EDSs) from three hospital in-patient streams (surgical, medical and mental health) with Australian standards. Methods An audit was performed of 120 EDSs extracted from a tertiary hospital. Auditors evaluated each EDS using an adaptation of the Australian Commission on Safety and Quality in Health Care's EDS toolkit. Results EDSs from all in-patient streams were lengthy and most did not include information regarding discharge destination, patient education or recommendations. General Medicine EDSs were most timely, averaging within 1 day of discharge. Conclusions Key areas of improvement remain for improving the timeliness, brevity and completeness of EDSs. Key areas identified for improvement include page length, discharge destination, alerts, patient education and recommendations. Variability in audit results between streams suggests the need for speciality-specific templates, standards and medical officer training. What is known about the topic? The literature suggests that an EDS is timely if it is completed within 2 days of discharge. A complete and brief EDS should also include key details of the care in two (or fewer) pages. What does this paper add? This paper evaluated 120 EDSs, compared them against a standard and stratified the EDSs according to three core clinical in-patient streams that produced them (surgical, medical and mental health). What are the implications for practitioners? Although broad guidelines for timeliness, brevity and completeness have been established for EDSs, each in-patient stream will require different standards. A hospital or health service should have established standards relevant to each in-patient stream. Before commencing a term in any of the three in-patient streams, medical officers who are to generate EDSs should be trained in the required standard. Training should highlight critical elements of a speciality stream to ensure EDS authors are aware of the nuances of the stream in which they are rotating. In addition, general practitioners should liaise with local hospitals to ensure ongoing dialogue and improvement of clinical handover documents.

Pharmacist-Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability.

Inaccurate or missing medication information in medical discharge summaries is a widespread and intractable problem. This study evaluated the effectiveness and sustainability of an intervention in which ward-based hospital pharmacists reviewed, contributed and verified medication information in electronic discharge summaries (EDSs) in collaboration with physicians. Retrospective audits of randomly selected EDSs were conducted on seven wards at a major public hospital before and after implementation of the intervention and repeated two years later on four wards where the intervention was incorporated into usual pharmacist care. EDSs for 265 patients (prescribed a median of nine discharge medications) were assessed across the three time points. Pharmacists verified the EDSs for 47% patients in the first post-intervention audit and 68% patients in the second post-intervention audit. Following the intervention, the proportion of patients with one or more clinically significant discharge medication list discrepancy fell from 40/93 (43%) to 14/92 (15%), p < 0.001. The proportion of clinically significant medication changes stated in the EDSs increased from 222/417 (53%) to 296/366 (81%), p < 0.001, and the proportion both stated and explained increased from 206/417 (49%) to 245/366 (67%), p < 0.001. Significant improvements were still evident after two years. Pharmacists spent a median of 5 (range 2–16) minutes per patient contributing to EDSs. Logistics, timing and pharmacist workload were barriers to delivering the intervention. Additional staff resources is needed to enable pharmacists to consistently deliver this effective intervention.

Admission of patients with acute urinary retention leads to a definitive management decision.

Acute urinary retention (AUR) is a common urologic emergency. However, its management is not standardized due to lack of clinical guidelines. We retrospectively reviewed the treatment of all male patients admitted to our institution with AUR over 12months. Data was obtained from the HIPE (Hospital Inpatient Enquiry) data system, each patient's electronic discharge summary and from patient medical records. There were 130 AUR admissions during the period. About 74 admissions were due to benign prostatic enlargement (BPE). Of these, 45.9% (n = 34) passed their trial without catheter (TWOC). The remainder (n = 40) failed their TWOC necessitating recatheterization and consideration for transurethral resection of prostate (TURP) or re-TWOC. An indwelling urinary catheter (IDC) was inserted for 27.5% (n = 11) of patients with a failed TWOC secondary to comorbidities. This group had a mean age of 78years (range 68-96years). Of those who failed their TWOC, 32.5% (n = 13) had a TURP on index admission. Of the remaining 16 patients with failed TWOC, 75% (n = 12) were discharged with an IDC and readmitted for an elective TURP with a median waiting time of 55days (range 17-138days). 18.75% (n = 3) passed a re-TWOC and thus offset the need to have any surgical intervention and 6.25% (n = 1) proceeded to a radical retropubic prostatectomy for biopsy proven prostate adenocarcinoma. Admission of patients with acute urinary retention leads to a definitive management decision and reduced prolonged catheterization.

An audit tool for assessing electronic discharge summaries of head and neck oncology patients

Supporting proactive and safe discharge is one of the national clinical indicators for Commissioning for Quality and Innovation (CQUIN) 2017/2019. Head and neck (HNC) oncology patients after major ablative and reconstructive surgery require comprehensive discharge summaries for GPs, their care workers and members of the HNC multidisciplinary team. We aimed to assess the quality of our unit's electronic discharge summaries (EDN) and developed a tool for this purpose.

Preoperative risk assessment for predicting the opening of mastoid air cells in lateral suboccipital craniotomy for microvascular decompression

ObjectiveOpening of mastoid air cells (MACs), a complication of lateral suboccipital craniotomy for microvascular decompression (MVD), might cause cerebrospinal fluid (CSF) leakage and meningitis. Only a few studies have investigated the association of degree of MAC development and actual opening of MACs. The present study focused on preoperative risk assessment for predicting the opening of MACs. Patients and methodsThe study included 204 consecutive patients who underwent MVD at our hospital between January 2014 and December 2018. We retrospectively collected clinical and neuroimaging data from electronic medical charts and discharge summaries. MACs were classified into four types according to neuroimaging data. Postoperative computed tomography (CT) was used to assess patients with and without CSF leakage into MACs. ResultsNo CSF leakage was observed into types 1 and 2 MACs, but it was noted in 14 of 46 patients (30 %) with type 3 and 44 of 58 patients (76 %) with type 4 MACs. Opening of MACs during surgery could not be recognized in 33 (57 %). CSF rhinorrhea was noted in 1 of the 58 patients with CSF leakage into MACs and meningitis was not noted. ConclusionPatients with types 3 and 4 MACs have a high risk of CSF leakage. Complete prevention of mild symptoms, such as ear obstruction, is challenging even if opened MACs are sealed, but serious complications, such as CSF rhinorrhea and meningitis, can be avoided. For cases in which preoperative CT reveals a high risk of opening of MACs, preventive closure should be performed.

122 Are We Effective Prescribers? A Retrospective Audit of DOAC Prescribing Post Embolic Stroke for Non Valvular Atrial Fibrillation

Abstract Background Direct oral anticoagulants (DOAC) are indicated for stroke prophylaxis in non-valvular atrial fibrillation, which is responsible for up to 20% of all ischaemic strokes(1). We performed a retrospective audit of all consecutive stroke patients in an Irish teaching hospital over a 1-year period to investigate the rate of incorrect dosing and any risk factors for this occurring. Methods We assessed our hospital stroke database from January to December 2017. Our research focused on DOAC prescribing in non valvular atrial fibrillation post embolic stroke. We collected data on baseline characteristics, choice of anticoagulation, dosing, and assessment of renal function, with follow up renal function if available. We reviewed electronic discharge summaries, online laboratory systems and completed a chart review. Results There was a total of 116 people with atrial fibrillation who developed an embolic stroke in our centre, of which 68 were eligible for anticoagulation using a DOAC (59). The main reasons for omission were CKD and haemorrhagic transformation. Patients were discharged on either Apixaban (32 patients), Rivaroxoban (32 patients), or Dabigatran (4 patients). Following our review, we established that 54/68 (79%) of patients were correctly anticoagulated. Over 20% of patients were incorrectly dosed and there was a clear tendency to under-dose 13/14 (93%). There were significant differences between the correct and incorrect dosing groups, with the latter group of patients being older and more at risk of polypharmacy. Renal function did not differ significantly between the groups at discharge or follow up and none of the incorrectly dosed patients were on a concurrent anti platelet. Conclusion A significant number of patients prescribed DOAC in hospital were not appropriately anticoagulated (21%), a majority of which were under-dosed. The patients who were under-dosed were older and more likely to be on 5 or more medications.

Automated electronic discharge summary for patients undergoing acute scrotal exploration: does it improve accuracy and quality?

The acute scrotum is a common emergency presentation, and the priority is to exclude testicular torsion, which typically requires scrotal exploration. The accuracy of electronic discharge summaries (EDSs) for patients undergoing acute scrotal exploration has previously been shown to be poor. The objective of this study was to assess accuracy of EDS in patients undergoing acute scrotal exploration in a tertiary paediatric hospital. This study aimed to determine if a new EDS system, whereby the operative procedure is automatically transcribed into the EDS, improves the information within the EDS. Retrospective review of the EDS for all patients undergoing acute scrotal exploration between 1st April 2014 and 31st March 2016 was carried out. During this period, a new EDS system, whereby the operative procedure is automatically transcribed to the EDS, was introduced on 20th June 2015. The old system (1st April 2014 to 19th June 2015) was compared with the new system (20th August 2015 to 31st March 2016). A total of 181 patients were included. A diagnosis was not documented in 25 (14%) and was inconsistent with the operation notes in 56 (31%). An operative procedure was not documented at all in 13 (7%) and was inconsistent with the operation notes in 43 (24%). The laterality of pain was not documented and/or incorrect in 11 (6%). The new system in which the operative procedure is automatically transcribed to the EDS resulted in an improvement of diagnoses (78% vs 96%; p=0.0022; old vs new) and procedures (95% vs 100%; p=0.0218; old vs new) being documented but not the accuracy. The EDS prepared for patients undergoing acute scrotal exploration frequently exhibit inaccuracies; a system that automatically transcribes the operative procedure into the EDS results in modest improvement.

Severe hyperbilirubinemia in newborns, risk factors and neurological outcomes

Hyperbilirubinemia is highly prevalent in newborns, with risk of neurological invol vement with bilirubinemia higher than 20 to 25 mg/dl. This progression is preventable with early de tection and treatment. To describe the incidence and associated factors in hospitalized pa tients with hyperbilirubinemia higher than 20 mg/dl, and the follow-up of symptomatic cases during hospitalization. Retrospective study of patients with severe hyperbilirubine mia, between 2013 and 2016. Risk factors were evaluated, stratifying by bilirubin level, admission age, and gestational age. The data were compared with Fisher's exact test, chi-square test, and relative risk (RR) in an Excel database, with an alpha error of p <0.05. The data were obtained from the electronic discharge summary and the medical record of secondary level follow-up. During the studied period, out of 25,288 live newborns (NB), 593 were hospitalized due to hyperbilirubinemia higher than 20 mg/dl, one per each 42 live NB; and 59 with bilirubinemia higher than 25 mg/dl, one per each 428 live NB. Hyperbilirubinemia was more frequent in males, with RR 1.22 (95% CI 1.04-1.44), and in late preterm newborns, with RR 2.39 (95% CI 1.96-2.93) compared with term NB. In those admitted with more than four days, the main associated factor was excessive weight loss, whereas in the first three days was classic group incompatibility. Three of ten cases with acute encephalopathy persisted with neurological involvement, which means 11.8 per 100,000 live births. The main risk factors for developing severe hyperbilirubinemia were prematurity, excessive weight loss, classic group incompatibility, and male sex. These findings allow to focus attention on risk groups and decrease the probability of neurological damage.

Trust-wide improvement of discharge summaries at University Hospital Southampton

The discharge summary is a document completed by hospital staff at the end of an admission to communicate inpatient information and ongoing plans with community care providers and the patient. The electronic discharge summary at University Hospital Southampton was developed 10 years ago. Following

Sähköisen moniammatillisen kotiutuslistan kehittäminen sairaalasta kotiutuksen tueksi

Potilaan sujuvan ja turvallisen kotiutumisen edistämiseksi tarvitaan kotiutuskäytäntöjen yhtenäistämistä ja sähköisen hoitotyön yhteenvedon tietosisällön parantamista. Kotiutuslistan käytöllä voidaan parantaa potilaan hoidon jatkuvuutta ja laatua. Se auttaa muistuttamaan hoidon jatkuvuuden kannalta oleellisista asioista hoitojakson aikana, ja sitä voidaan hyödyntää esimerkiksi sähköisen hoitotyön yhteenvedon laatimisessa.&#x0D; Kuvaamme tässä artikkelissa moniammatillisen kotiutuslistan tietosisällön kehittämistä hoitokertomukseen potilaan tulotilanteen ja hoitojakson aikaisen kirjaamisen yhtenäistämiseksi kirjallisuuden sekä erikoissairaanhoidossa, perusterveydenhuollossa ja sosiaalipalveluissa työskentelevien ammattilaisten (n = 82) yhteistyön tuloksena.&#x0D; Kotiutuslistaan sisällytettiin aikaisemman kirjallisuuden, käytössä olleiden paperisten kotiutuslistaesimerkkien ja moniammatillisten työryhmien tuotoksena syntyneitä potilaan turvallisen kotiutuksen kannalta keskeisiä tarkasteltavia asioita. Kotiutuslista pilotoitiin Satakunnan sairaanhoitopiirissä. Pilotointi toteutettiin kolmella keskussairaalan vuodeosastolla, keuhkosairauksilla, sisätaudeilla ja neurologialla, sekä vanhuspsykiatrian ja kuntoutuksen vuodeosastoilla paperimuodossa. Pilotoitu tietosisältö siirrettiin sähköiseen muotoon Effican hoitokertomukseen (hokeen) osaksi potilaan kliinistä hoitosuunnitelmaa.&#x0D; Moniammatillinen kotiutuslista otettiin pilotin jälkeen käyttöön Satakunnan erikoissairaanhoidon palveluissa. Kotiutuslistan keskeisimmät jatkokehittämistarpeet kohdistuvat asiakas- ja potilasnäkökulman esille saamiseen sekä sen tekniseen toimivuuteen potilastietojärjestelmässä.

Quality of e-discharge summaries at a district general hospital

A standardised high-quality electronic discharge (e-discharge) summary ensures continuity of care of patients in the community. They are integral to bridging the gap between secondary and primary care by ensuring safe transfer of information. Poor communication can cause patient harm and significant incidents. The aim was to assess our local practice by reviewing e-discharge summaries, in order …

Four-year review of admissions to a South African regional hospital general surgery department.

There are limited published data describing surgical admissions at a regional hospital level in the South African (SA) context. To retrospectively review data from an electronic discharge summary database at a regional SA hospital from 2012 to 2016 to describe the burden of surgical disease by analysing characteristics of the patients admitted. All discharge summary records for the 4-year period were reviewed after extraction from a database created for the surgery department. Admissions were classified into 5 types: (i) elective surgery or investigations (ESI); (ii) trauma; (iii) burns; (iv) non-traumatic surgical emergencies (NTSE); and (v) unplanned readmission within 30 days. Other variables reviewed were demographic data, the International Statistical Classification of Diseases and Related Health Problems - Version 10 (ICD-10) diagnosis; area of origin; and outcome (death, tertiary referral, discharge). Data were subgrouped into 12-month periods to facilitate trend analysis. Discharge summaries (N=9 805) over the 4-year study period were assessed and 9 799 were included in the analysis. All data were entered by the attending medical personnel. A total of 5 647 male patients (57.6%) and 4 152 female patients (42.4%) were admitted, with a mean age of 43.3 years (95% confidence interval (CI) 43.0 - 43.8) and a mean length of stay of 4.9 days (95% CI 4.7 - 5.1). Male patients comprised a larger proportion of trauma (83.7%) and burn (63.9%) admissions. The mean length of stay ranged from 3.5 days for elective patients to 9.1 days for burn patients. The most common diagnoses for emergency admissions were appendicitis, peripheral vascular disease and peptic ulcer disease. Common diagnoses for elective admissions were gallstone disease, inguinal hernia, anal fistulas/fissures, and ventral and incisional hernia. The most common cancer diagnoses were of the colorectum, oesophagus, breast and stomach. The overall mortality rate was 2.2%, and highest by subtype was burn patients (6.3%). Trend analysis showed a statistically significant increase in admission for NTSE (p=0.019), trauma (p&lt;0.001) and 30-day readmission rates (p&lt;0.001), with a decrease in admissions for ESI (p=0.001) over the 4 years. A precise understanding of the burden of disease profile is essential for national, provincial and district budgeting and resource allocation. Ongoing surveillance such as that performed in the study provides this critical information.

Spectrum of rhabdomyolysis in an acute hospital

Rhabdomyolysis is a state of muscle necrosis with the hallmark being elevated creatine kinase that may cause acute kidney injury with serious consequences. It happens in many clinical settings. We sought to investigate all cases of rhabdomyolysis admitted to an acute hospital in Ireland over one calendar year. All cases of rhabdomyolysis admitted to a tertiary hospital over a 12-month period were reviewed. It was defined as serum creatine kinase greater than five times upper limit normal. The incidence, presenting characteristics and clinical outcomes, was collected from electronic records, electronic consult system and discharge summaries. Rhabdomyolysis was observed in 306 (1.7%) of all 18,297 admissions. It was seen most commonly in the setting of acute coronary syndrome (19.6%), post-operative state (18.0%), long-term confinement in the same position (16.3%), infection (9.2%) and seizures (6.5%). Overall mortality in this group was 16%. Acute kidney injury occurred in 43% of patients. Those with severe acute kidney injury (stage 3) had a mortality of 50%. Length of stay was significantly prolonged in the presence of acute kidney injury (p < 0.001). Surprisingly, in 44% of those with acute kidney injury, nephrology advice was not requested. Rhabdomyolysis is a common and a serious clinical condition across many specialties in an acute hospital that would likely benefit from nephrology involvement should acute kidney injury supervene.

Evaluation of an electronic health record structured discharge summary to provide real time adverse event reporting in thoracic surgery

BackgroundThe reporting of adverse events (AE) remains an important part of quality improvement in thoracic surgery. The best methodology for AE reporting in surgery is unclear. An AE reporting system...

Integrated Electronic Discharge Summaries-Experience of a Tertiary Pediatric Institution.

Succinct and timely discharge summaries (DSs) facilitate ongoing care for patients discharged from acute care settings. Many institutions have introduced electronic DS (eDS) templates to improve quality and timeliness of clinical correspondence. However, significant intrahospital and intraunit variability and application exists. A review of the literature and guidelines revealed 13 key elements that should be included in a best practice DS. This was compared against our pediatric institution's eDS template-housed within an integrated electronic medical record (EMR) and used across most inpatient hospital units. Uptake and adherence to the suggested key elements was measured by comparing all DSs for long stay inpatients (> 21-day admission) during the first year of the EMR eDS template's usage (May 2016-April 2017). A total of 472 DSs were evaluated. Six of 13 key elements were completed in > 98.0% of DSs. Conversely, only < 5.0% included allergies or adverse reaction data, and < 11.0% included ceased medications or pending laboratory results. Inclusion of procedure information and pending laboratory results significantly improved with time (p = 0.05 and p < 0.04, respectively), likely as doctors became more familiar with EMR and autopopulation functions. Inclusion of "discharge diagnosis" differed significantly between medical (n = 406/472; 99.0%) and surgical (n = 32/472; 51.6%) DSs. Uptake and adherence to an EMR eDS template designed to meet best practice guidelines in a pediatric institution was strong, although significant improvements in specific data elements are needed. Strategies can include a modification of existing eDS templates and junior medical staff education around best practice.

Audit of ophthalmology discharge summaries in a Nigerian Teaching Hospital.

Background: Discharge summaries are important components of hospital-care transitions in ensuring continuity of care. Aim: We assessed the adequacy and accuracy of discharge summaries written by junior doctors. Methods: An instrument, adapted largely from the current hospital discharge summary template and recommendations regarding content from the Joint Commission International, was used to study 420 discharge summaries written in 2012 from the ophthalmology service of a Rural Teaching Hospital in Nigeria. The simple descriptive analysis was done with Statistical Package for the Social Science version 17. Results: Completeness of entries was relatively high in many traditional areas (biodata of patient, admission/discharge dates, name of supervising consultant, principal diagnosis, surgical procedures done, follow-up instructions, and condition on discharge) of the summaries. The portion of the paper-based template titled “summary” of the admission was most problematic; with information on medication changes and result of tests missing in 368/420 (87.6%) and 334/420 (79.5%), respectively. Conclusion: Educational intervention for doctors in training with the provision of oversight and feedback by their supervisors is required. Standardized discharge summary templates recognizing the peculiarities of specialized patient groups are recommended. Transition to electronic discharge summary system is imperative.

An audit of the accuracy of medication information in electronic medical discharge summaries linked to an electronic prescribing system.

Poor communication of medication information to general practitioners when patients are discharged from hospital is a widely recognised problem. There has been little research exploring the accuracy of medication information in electronic discharge summaries (EDS) linked to hospital e-prescribing systems. To evaluate the accuracy of medication lists and medication change information in EDS produced using an integrated e-prescribing and EDS system (where EDS discharge medication lists were imported from discharge e-prescription records, medication change information was manually entered, and medications were dispensed from paper copies of the patients' e-prescriptions). Retrospective audit of EDSs for a random sample, representative of adult patients ( n = 87) discharged from a major teaching hospital. EDS medication lists were compared to pharmacist-verified paper discharge prescriptions (considered to be the most accurate discharge medication list) to identify discrepancies. EDS medication change information was compared to medication changes identified by comparing pharmacist-verified "Medication History on Admission" forms with pharmacist-verified paper discharge prescriptions. There were 85/87 (98%) EDSs that included a discharge medication list. Of these, 50/85 (59%) contained one or more medication list discrepancies (median 1, range 0-15). The most common discrepancy was omission of medication (58%); 84/131 (64%) discrepancies were considered clinically significant (risk of adverse outcome); 162/351 (46%) clinically significant medication changes were stated in the EDS; and 153/351 (44%) changes were both stated and included a reason. EDS discrepancies were common despite integration with e-prescribing. Eliminating paper prescriptions, enhancing e-prescribing/EDS functionality and involving pharmacists in EDS preparation may reduce discrepancies.

Implementation of a Peer-to-Peer Teaching Intervention Improved Electronic Discharge Summary Documentation by New Internal Medicine Residents

The early months of residency training (EMCT) from July to September can be overwhelming for interns, or post-graduate year one (PGY1) residents. Traditional orientation may not be sufficient to ensure a smooth transition to residency. Interns are responsible for completing discharge summaries in most training hospitals but receive little or no prior training. The objective of this study was to determine the effectiveness of a peer-to-peer orientation of new (incoming) PGY1 internal medicine residents by present (outgoing) PGY1 residents. This was an observational, analytical (cohort), single-center study. The intervention group, new (incoming) 2016 internal medicine, or PGY1, residents were exposed to a 2-h peer-to-peer orientation, in addition to the traditional orientation process. The internal medicine residents from the previous year (2015 PGY1 residents), exposed to only the traditional orientation process (TOP) prior to their commencement of residency, served as the control group. A comparison between the groups’ discharge summary documentation (DC summary) was performed using an independent two-sample t test; linear regression analysis was applied to control for potential confounders. Statistically significant differences were found in mean discharge summary scores between the intervention and control group. The intervention group had a higher average score (mean 73.6; standard deviation (SD) 12.3; 95% confidence interval (CI) 68.0–79.1) than the control group (mean 65.7; SD 7.9; 95% CI 62.5–69.0). Using a two-tailed independent t test, the mean difference between both groups was found to be 7.8, or 12% (95% CI 1.8–13.8; p = 0.012). This highly portable intervention may improve discharge summary documentations by new PGY1 residents during EMCT if implemented nationwide.

A Systematic Review of Interventions to Follow-Up Test Results Pending at Discharge.

Patients are frequently discharged from the hospital before all test results have been finalized. Thirty to 40% of tests pending at discharge (TPADs) return potentially actionable results that could necessitate change in the patients' management, often unbeknownst to their physicians. Delayed follow-up of TPADs can lead to patient harm. We sought to synthesize the existing literature on interventions intended to improve the management of TPADs, including interventions designed to enhance documentation of TPADs, increase physician awareness when TPAD results finalize post-discharge, decrease adverse events related to missed TPADs, and increase physician satisfaction with TPAD management. We searched Medline, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Database of Controlled Clinical Trials and Medline (January 1, 2000-November 10, 2016) for randomized controlled trials and prospective, controlled observational studies that evaluated interventions to improve follow-up of TPADs for adult patients discharged from acute care hospitals or emergency department settings. From each study we extracted characteristics of the intervention being evaluated and its impact on TPAD management. Nine studies met the criteria for inclusion. Six studies evaluated electronic discharge summary templates with a designated field for documenting TPADs, and three of six of these studies reported a significant improvement in documentation of TPADs in discharge summaries in pre- and post-intervention analysis. One study reported that auditing discharge summaries and providing feedback to physicians were associated with improved TPAD documentation in discharge summaries. Two studies found that email alerts when TPADs were finalized improved physicians' awareness of the results and documentation of their follow-up actions. Of the four studies that assessed patient morbidity, two showed a positive effect; however, none specifically measured the impact of their interventions on downstream patient harm due to delayed follow-up of TPADs. Three studies surveyed physicians' attitudes towards the interventions, of which two studies reported improved physician satisfaction with TPAD management with the implementation of an enhanced discharge template and a notification system when TPADs finalize. Discharge summary templates, educational interventions for discharging physicians, and email alerts when TPAD results are finalized show promise in improving management of TPADs. Given the complexity of the processes necessary to ensure follow-up of TPADs, rigorous evaluations of multifaceted interventions (e.g., improved discharge documentation of TPADs combined with email alerts when results become available) is needed.

Audit of ophthalmology discharge summaries in a Nigerian Teaching Hospital.

Discharge summaries are important components of hospital-care transitions in ensuring continuity of care. We assessed the adequacy and accuracy of discharge summaries written by junior doctors. An instrument, adapted largely from the current hospital discharge summary template and recommendations regarding content from the Joint Commission International, was used to study 420 discharge summaries written in 2012 from the ophthalmology service of a Rural Teaching Hospital in Nigeria. The simple descriptive analysis was done with Statistical Package for the Social Science version 17. Completeness of entries was relatively high in many traditional areas (biodata of patient, admission/discharge dates, name of supervising consultant, principal diagnosis, surgical procedures done, follow-up instructions, and condition on discharge) of the summaries. The portion of the paper-based template titled "summary" of the admission was most problematic; with information on medication changes and result of tests missing in 368/420 (87.6%) and 334/420 (79.5%), respectively. Educational intervention for doctors in training with the provision of oversight and feedback by their supervisors is required. Standardized discharge summary templates recognizing the peculiarities of specialized patient groups are recommended. Transition to electronic discharge summary system is imperative.