Quality Of Discharge Summaries Research Articles

Assessment the of Quality of Discharge Summaries for Elective and Emergency Surgical Procedures at a Government Medical College Hospital in India

Assessment the of Quality of Discharge Summaries for Elective and Emergency Surgical Procedures at a Government Medical College Hospital in India

Effect of integrated medicines management on quality of discharge medication information - a secondary endpoint in a randomized controlled trial.

High-quality discharge information is important to promote patient safety when patients are transferred from hospital to primary care. Patients with multiple long-term conditions are especially vulnerable to insufficient transfer of medication information, as they use many medications and have complex interactions with the healthcare services. The aim of this study was to investigate the effect of integrated medicines management provided to hospitalized multimorbid patients on the quality of the discharge medication information. Multimorbid patients ≥18 years, using a minimum of four regular medications from a minimum of two therapeutic medication classes were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a pre-specified secondary endpoint analysis of a randomized controlled trial; the difference between the intervention and control group in the quality of discharge medication information. The analysis population comprised 384 patients. Integrated medicines management improved the discharge summary quality score of the medication information from 5.8 ± 1.5 to 8.6 ± 2.6 (mean difference 2.7, 95% CI 2.3-3.2, p < 0.001). In total 171 intervention patients (89%) received a patient discharge information letter, compared to 66 control patients (35%), p < 0.001. The quality score of the medication information in the patient discharge information letter was improved from 6.0 ± 1.8 in the control group to 10.0 ± 1.3 in the intervention group (mean difference 4.0, 95% CI 3.6-4.4, p < 0.001). Integrated medicines management delivered to multimorbid patients during a hospital stay improved the quality of the medication information in discharge summaries as well as patient discharge information letters and ensured that a discharge information letter in lay language was prepared for almost all patients who were involved in the management of their medications after discharge.

Application of AI in the creation of discharge summaries in psychiatric clinics.

The integration of artificial intelligence (AI; ChatGPT 4.0) into medical workflows presents a great potential to enhance efficiency and quality. The use of artificial intelligence in the creation of discharge summaries seems particularly interesting and valid. The course of each hospitalization is described in the discharge summary, which is given to each patient and then to his general practitioner at the end of hospital treatment. An exploratory analysis of discharge summaries in psychiatric clinics underscores that these documents must fulfill diverse and specific requirements. Nevertheless, AI-generated discharge summaries offer the opportunity to optimize information transfer and alleviate the workload on physicians. The study evaluates the quality of discharge summaries produced by clinical staff and by an AI model (ChatGPT 4.0). The clinicians involved in writing of the discharge summaries were not informed about the study's purpose or methodology. The completed summaries were subsequently assessed by four attending physicians using predefined criteria. These physicians were also blinded to the study's objectives and were unaware of the individual authors of the summaries. The evaluation criteria included consistency, completeness, and comprehensibility. Additionally, the time required to prepare these summaries and its impact on overall quality were analyzed. The results of the study indicate that discharge summaries generated by AI are more efficient than discharge summaries prepared by clinic staff. The AI was particularly effective in terms of coherence and information structure. Further research, training and development is needed to improve the accuracy and reliability of AI-generated discharge summaries.

357 An Audit of Quality of Discharge Summaries in Cardiac Surgery

357 An Audit of Quality of Discharge Summaries in Cardiac Surgery

Information sharing following discharge of psychiatric inpatients: Improving the quality of discharge summaries

Abstract: BACKGROUND: Discharge summaries are valuable clinical documents providing information not only about the acute presentation and progression but also suggestions for future management to maintain the continuity of care. This is important in multidisciplinary, multiagency mental healthcare. AIM: It was intended to evaluate the discharge summaries for adult psychiatric inpatients, about the information shared such as the reason for admission, diagnoses, medications, progress in the ward, and legal status with an overarching aim to inform about the quality improvement of discharge summaries. METHODS: It was a service evaluation of a stratified random sample of 86 discharges from younger adult psychiatry wards, from which 73 discharge summaries were evaluated. RESULTS: The sample had 44 male and 42 female patients, with an average inpatient stay of 27.3 ± 40.8 days. Most (81.4%) of the patients had informal admission. Most patients (96.5%) had a psychiatric diagnosis; the common diagnoses were schizophrenia (24.4%), bipolar disorder (15.1%), personality disorder (17.4%), and depression (11.6%). Discharge summaries were sent on an average of 21.3 + 17.7 days (median 15 days). Most discharge summaries mentioned psychiatric diagnoses (97.3%), list of medications and dosage (95.9%), legal status during admission (74.0%), reason for admission (97.3%), and progress in the ward (97.3%). CONCLUSIONS: There is a scope to improve discharge summaries by adopting an appropriately structured format containing essential clinical information, which can be useful for maintaining continuity of patient care.

67 Audit of discharge summaries on a geriatric ward against the Health Information and Quality Authority (HIQA) National Standard

Abstract Background Discharge summaries are integral for safe transition of patient care. Complete, precise and succinct documentation can ensure improved quality of care and patient safety. Methods Retrospective data were collected from e-discharge summaries that were generated over a 7-month period from June-Dec 2022. A total of 20 samples were selected at random and assessed against the HIQA National Standard. The samples were compared to the physical medical records to countercheck if relevant information were present or omitted. There was a total of 78 outcomes measured as per the national standard. Results There were 8 (40%) discharge summaries with the complete clinical courses, in that they contained the main complaint, relevant clinical findings, relevant investigations results and the complete treatment courses. There were 4 (20%) summaries that had omitted documentation of inpatient complications or adverse events and 8 (40%) summaries had omissions present on medication prescriptions. There were 5 (25%) summaries whereby the list of stopped medications and the reasons for stopping the respective medications were omitted. There were 5 (25%) summaries with incomplete documentation of future plans. Only 4 (20%) discharge summaries had all the relevant information present. Conclusion Efforts to implement E-prescribing and electronic health records should be prioritised. The Irish Medical Council plans to introduce Entrustable Professional Activities (EPA), which are essential tasks that a trainee can be trusted to perform without direct supervision, once sufficient competence has been demonstrated. An entire EPA unit is dedicated to competent patient handover and discharge. A Discharge Summary Flowchart which highlights the inclusion of all the essential components of a complete discharge summary was introduced as a guide for the team. Finally, there is an ongoing continuous audit by Senior House Officers and Interns to assess the quality of discharge summaries after the recommendations have been implemented.

WTP6.13 A closed loop audit on the Quality of Electronic Discharge Summaries within General Surgery

Abstract Aim Following surgical admissions, Electronic Discharge Summaries (EDS) are vital to ensure patient safety through continuity of care to the primary care setting. It is also an official record to the patient about the treatment and care they received including any further treatment or follow up appointments they require and is therefore important they are not only accurate but detailed with all the relevant information included. Methods An audit of Electronic Discharge Summaries within a busy Emergency General Surgery department was undertaken using a gold standard which was established by using the 20 most important parameters within the standardized proforma. If a discharge summary had 80% or more parameters sufficiently completed it was deemed to be adequate. A first and second cycle of data collection of 100 EDS’s were undertaken and analysed using the gold standard criteria. Results A first cycle data collection of 100 EDS’s were analysed, it was found only 55% of these were adequate following the standard set. An educational teaching session to doctors at a local meeting was carried out to explain why 45% of the discharge summaries were not complaint with the standard set. The second cycle showed 91% of EDS’s to be of adequate standard. Conclusion This audit has shown that adhering to a gold standard template can significantly improve the quality of discharge summaries. A re-audit in 12 months should be carried out to ensure standards have been maintained.

The Quality of Discharge Summaries at Al-Shaab Hospital, Sudan, in 2022: The First Cycle of a Clinical Audit.

Background The discharge summary is a vital component of the modern health system. It is defined as a synopsis of information regarding events occurring during the inpatient care of a patient, to allow for a safe, quick, and effective patient-centered discharge process. It contains important information about the patient's hospital stay, including the reason for admission, treatment received, and follow-up needed. Low-quality discharge summaries pose a great risk to patient healthcaresince the most frequent reason for error in clinical settings is poor communication.In the United Kingdom, the Professional Record Standards Body (PRSB) has adopted the Academy of Medical Royal Colleges (AoMRC) "Standards for the Clinical Structure and Content of Patient Records" and produced a standard discharge summary form. This study aimed to assess the quality of discharge summaries at Al-Shaab Hospital in Sudan in terms of information, filling adequacy, and adherence tointernational guidelines and evaluate the discharge interviews. Methods A cross-sectional institution-based study was conducted in the period of September to December 2022 at Al-Shaab Teaching Hospital in Khartoum, Sudan. Systematic random sampling was used to select the study participants from the discharged patients. A total of70patients were met in their wards over a period of two months, and the contents of their discharge cards were compared to items on an online checklist based on the Professional Record Standards Body (PRSB) and the Academy of Medical Royal Colleges (AoMRC) standard discharge summary. The patients were also interviewed to assess their knowledge regarding their discharge information. Results The hospital's discharge summary formcontained only four headings: date, patient name, age, and ID number. The assessed cards were found to be missing valuable information, including date of admission (missing in 83%), filling doctor's name (missing in 71%), and medication changes (missing in 70%). Only half of the summaries were clearly readable. The majority of patients had poor knowledge regarding their medication side effects (89%) and how to act in an emergency (86%), while knowledge of medication doses and follow-up details was good in 80% and 66%, respectively. Conclusion The patients are discharged with inadequately filled discharge forms. This may be due to the poor design of the form, so a newly designed form will be proposed, based on international standards. The discharge interview is also in need of improvement, to make sure patients are fully aware of their condition.

The Quality of Discharge Summaries After Acute Kidney Injury.

Acute kidney injury (AKI) increases the risk of hospital readmission, chronic kidney disease, and death. Therefore, effective communication in discharge summaries is essential for safe transitions of care. The objectives of this study were to determine the quality of discharge summaries in AKI survivors and identify predictors of higher quality discharge summaries. Retrospective chart review. Tertiary care academic center in Ontario, Canada. We examined the discharge summary quality of 300 randomly selected adult patients who survived a hospitalization with AKI at our tertiary care hospital, stratified by AKI severity. We included 150 patients each from 2015 to 2016 and 2018 to 2019, before and after introduction of a post-AKI clinic in 2017. We reviewed charts for 9 elements of AKI care to create a composite score summarizing discharge summary quality. We used multivariable logistic regression to identify predictors of discharge summary quality. The median discharge summary composite score was 4/9 (interquartile range, 2-6). The least frequently mentioned elements were baseline creatinine (n = 55, 18%), AKI-specific follow-up labs (n = 66, 22%), and medication recommendations (n = 80, 27%). The odds of having a higher quality discharge summary (composite score ≥4/9) was greater for every increase in baseline creatinine of 25 μmol/L (adjusted odds ratio [aOR]: 1.27; 95% confidence interval [CI]: 1.03, 1.56), intrarenal etiology (aOR: 2.32; 95% CI: 1.26, 4.27), and increased AKI severity (stage 2 aOR: 2.57; 95% CI: 1.35, 4.91 and stage 3 aOR: 3.36; 95% CI: 1.56, 7.22). There was no association between discharge summary quality and the years before and after introduction of a post-AKI clinic (aOR: 0.77; 95% CI: 0.46, 1.29). The single-center study design limits generalizability. Most discharge summaries are missing key AKI elements, even in patients with severe AKI. These gaps suggest several opportunities exist to improve discharge summary communication following AKI.

Medication reconciliation and discharge communication from hospital to general practice: a quantitative analysis.

The aim of this study was to assess the quality of effective discharge communication to primary practice from a hospital that uses ieMR (integrated electronic Medical Record), a complete electronic prescribing/medical record platform. A retrospective quantitative analysis of 232 discharge encounters from a major tertiary hospital assessed the discharge summary quality; timeliness, completeness and medication information. Median time to discharge summary was 1day. 22.0% of discharge summaries were incomplete at 30days post discharge and 44.5% of discharge summaries were incomplete at 30days post discharge if discharged on a weekend compared to weekday (P-value=0.001). Rates of medication reconciliation were completed at approximately 35% at each point of the patient stay and 56.9% of patients had a GP discharge summary listing discharge medications. However, if certain progressive steps were completed (i.e. Home Medications recorded in ieMR, Discharge Reconciliation in ieMR, and Patient Discharge Medication Record in eLMs (Enterprise-wide Liaison Medication System)), then, the 'Medications on Discharge' was significantly more likely to be present in the discharge summary, at rates of 70.1%, 85.9%, and 98.6% respectively (P-value=0.007, <0.001, <0.001). Conversely not doing these steps dropped rates of having medications listed in the discharge summary to 50.0%, 40.3% and 34.1% respectively. This study assessed current discharge summary quality since the introduction of electronic medical records. It demonstrated the significant value of correct use of electronic programs, including performing all crucial steps of reconciliation. Targeted interventions in future studies that rectify the shortfalls in discharge communication are warranted.

158 AN AUDIT ON DISCHARGE SUMMARIES IN A MEDICAL GERONTOLOGICAL WARD

Abstract Background Discharge summaries are an integral part of communication within healthcare to ensure safe care across settings. Alterations are documented and relayed between relevant healthcare professionals. This audit evaluates quality of discharge summaries from a medical gerontology ward against the National Standard for Patient Discharge Summary Information (HIQA) Methods A retrospective audit was carried out with data collected from a ward discharge registry over 3-months (February-April 2022) and associated discharge summaries. Results A total of 31 discharges (including death) were identified during the set period, 97% (n=30) of which had completed discharge summaries. Upon assessment against the standard, 100% (n=30) included details vital to patient identification including name, date of birth, gender and address. In addition,100% (n=30) included information on date of admission-discharge, clinical course, relevant investigations, treatments, procedures, discharge medications and details of the doctor completing the discharge summary. The audit identified that 20% (n=6) of summaries stated referral source, which is mandatory according to the standard. 13% (n=4) included dietary interventions and 0% included immunization information (whether as an inpatient or prior). Regarding information on further management, 77% (n=23) had guidance on follow-up hospital care, 27% (n=8) had information about social care actions, 20% had advice, recommendations and future plans documented and in 10% information was documented to be given to patient and carer. Conclusion Compliance with mandatory information including patient details, admission/discharge date, diagnoses, hospital course, and author fully met the standard. However, there was poor compliance with information relevant to continuation of patient care in the community. This is particularly relevant for older patients with multiple co-morbidities and complex care needs. Doctors working on this ward are receiving education regarding the importance of documentation of functional status, social care needs and diet at discharge. In future, mandatory documentation as part of electronic discharge summaries may improve compliance and continuity of care across settings.

Improving and Sustaining the Quality of Discharge Summaries.

High quality discharge information communication has been linked to a reduction in the incidence of adverse events, decreasing the risk of prescription errors and lost follow up. In this paper we describe how our trust-wide quality improvement project, led by acute physicians, successfully improved discharge documentation. We demonstrate how we identified obstacles to continued success, and the interventions we implemented. We recommend how discharge summary quality can be optimised through training of junior doctors, recruitment of local champions, and use of novel methods to preserve engagement, such as gamification.

976 QUALITY OF DISCHARGE SUMMARIES FROM A CARE OF THE ELDERLY WARD—A QUALITY IMPROVEMENT PROJECT

Abstract Introduction Deficits in transfer of information between secondary and primary care are common but can have significant impact on patient care and can often be dangerous as well. It’s hard to quantify the quality of a discharge summary but certain parameters can be reasonably used as its surrogate. Method After review of literature from multiple sources, we identified 6 key indicators to assess quality of discharge summaries for patients discharged from a Care of the Elderly ward. In round 1, we collected data from 129 discharge summaries created over a period of 12 months. After analysis of data, a plan including education of doctors, posters display in wards and emphasis on compliance in ward rounds and MDTs was implemented. Round 2 of the QIP was performed 4 months later and data was collected from 50 discharge summaries. Results Significant improvement in compliance seen in all areas assessed which include; 1. Main diagnosis during admission—improved from 93% to 100% 2. Mobility at discharge—Improved from 31% to 82% 3. Resuscitation status—improved from 6% to 86% 4. Medication changes during admission and their rationale—20% to 62% 5. Discharge destination—66% to 96% 6. Social care requirements e.g. package of care etc.—59% to 82%. Conclusion Plan implemented after round 1 has led to a significant improvement in quality of discharge summaries which consequently results better communication between secondary and primary care. This improvement especially surrounding medication changes translates into better continuity of care and patient safety.

662 ENHANCING CARE BY IMPROVING DISCHARGE SUMMARIES

Abstract Introduction Within the Geriatric Medicine department at the Lister Hospital, Stevenage, the timeliness and quality of discharge summaries had become a source of complaints. Both primary care practitioners and families reported documentation was inadequate or incorrect. This project aimed to improve the quality of these discharge summaries in accordance with standards generated from previous audit data. Through improving communication it was clear that patient care could be enhanced. Methods Each month 15 discharge summaries were selected at random for review. Alongside patient notes these summaries were appraised in regards to standard discharge summary requirements: timeliness of delivery; adequate description of admission; and documentation of the follow up plan. They were also appraised on documentation of specific requirements for older aged adults including cognitive status, mobility status, discharge destination, need for home help, Rockwood Frailty score and resuscitation and escalation plans. Interventions including informal communication with junior doctors, circulation of a ‘Top Tips’ sheet, generation of an information poster and dissemination of information at local teaching sessions, took place, and were assessed, over regular PDSA cycles. Results showed a clear, sustained improvement in the quality of the discharge summaries. At the end of data collection, 100% of discharge summaries contained an adequate description of admission and an appropriate follow up plan. There was also significant improvement in documentation of specific requirements. Where documentation was initially very limited, following interventions, most discharge summaries contained details pertaining to discharge destination, need for home support, mobility status and resuscitation and escalation plans. Conclusion The relatively simple interventions have been found to have a sustained improvement in the quality of discharge summaries from the Geriatric Medicine Department at Lister Hospital, Stevenage. Whilst more work needs to be done it is hoped that this will already have enhanced patient care.

366 An Audit of Electronic Discharge Summaries and the Impact of Dedicated Teaching and Training in an Emergency Surgical Unit

Abstract Introduction Electronic discharge summary forms a vital part of a patient’s journey. As established in GAIN Guidelines 2011 ‘Clear and complete documentation in a patient’s health record is directly linked to the quality of the care they receive’. By improving the quality of E-Discharge summaries this will help to improve patient outcomes. Method In the Emergency surgical unit [EMSU] there are over 3500 completed consultant episodes per annum. We audited the quality of E-Discharges using 33 separate parameters included in the Trust’s dedicated discharge proforma. An E-Discharge summary was considered acceptable if &amp;gt;90% of the information was recorded accurately. Discharge failure rate was audited in a randomised sample of 20 discharges in November 2019 and one year later in November 2020 following implementation of specific training and teaching at induction on E-Discharge compilation. Results In November 2019 the discharge failure rate was 60%. Common failings were in general omission of data, lack of follow-up planning and inaccurate pharmaceutical arrangements. In November 2020, following dedicated teaching at induction, failure rate was 15%. Where accurate recording of demographic information and pertinent inpatient detail improved, shortcomings remained in inadequate recording of follow-up care and ongoing involvement of the primary healthcare team. Conclusions E-Discharge recording is sub-standard. It is often the remit of the least experienced member of the medical team, as is the case in our unit. We have shown that dedicated teaching and training in this area can improve the quality of discharge summaries.

EP.TU.281Mind the Gap: Improving the Quality of Neurosurgical Discharge Summaries

Abstract Aims A discharge summary is a permanent record of a patient’s hospital visit and the primary means of handover between care providers. Studies show they often lack precision and omit important information. This may compromise quality and continuity of care yet they are frequently written by the most junior clinicians on a ward with little guidance or formal education on how to write one. The aim of this study was to develop some specific guidelines to improve the quality of discharge summaries in a busy neurosurgical unit. Methods A survey was designed to identify the challenges faced by junior medical staff in writing discharge summaries. The essential components of a good neurosurgical discharge summary were identified by group of senior neurosurgeons. Summaries were retrospectively audited against these components. We then designed a simple visual aid and placed it above computer stations in the junior doctors’ offices. Formal departmental teaching session followed. After three months we re-audited the discharge summaries retrospectively to measure any effect of our intervention. Results Half of the neurosurgical team rated summaries as below expectations. Challenges included poor ward round documentation and a lack of clear expectations regarding structure and essential components. After the intervention, ward round documentation and discharge summary quality improved dramatically. Conclusions Although various recommendations about writing good discharge summaries exist, they are generally vague and not specific to neurosurgical practice. The development of a simple specialty specific discharge summary guide can improve discharge summary quality and should be encouraged in all specialties.

Exploring pharmacist involvement in the discharge medicines reconciliation process and information transfer to primary care: an observational study.

Background Medication errors can occur because of incomplete or poorly communicated information at the transition from hospital to community. Following an audit in 2016, a project was undertaken to determine if pharmacists could improve the quality of medication information in discharge summaries by introducing a discharge medication reconciliation process. Pharmacists recorded any changes to the patient's medication in the electronic prescribing system during their inpatient stay and summarised these changes on discharge. Objective To compare medication information in discharge summaries with recognised standards for the clinical structure and content of patient records, and to assess the impact of the pharmacist process on compliance with certain elements of these standards. Setting A 750 bed teaching district general hospital in England. Method A retrospective observational study examining all patient discharge summaries over a 1week period for compliance to national standards. Main outcome measure The main outcome measures were compliance with standards for medication started, stopped or changed in hospital and any differences between extent of recording this information by doctors and pharmacists. Results Data were collected and analysed for 243 patients, of whom 94 (38.7%) attracted a discharge medicines reconciliation process by a pharmacist. Discharge summaries were compliant with basic standards for changed medication in 42% of patients or 51.4% with the input of a pharmacist. This increase of 9.4% was statistically significant (p = 0.0365). At an enhanced level, pharmacists increased compliance from 39.1 to 46.5%, this did not represent a significant increase (p = 0.0989). Conclusion Pharmacists undertaking a discharge medication reconciliation process significantly improves the quality of discharge summaries.

A retrospective analysis of discharge summaries from a tertiary care hospital medical oncology unit: To assess compliance with documentation of recommended discharge summary components.

BackgroundDischarge summaries are essential for health transition between inpatient hospital teams and outpatient general practices. The patient's outcome is dependent on the quality and timeliness of discharge summaries.AimA retrospective analysis was carried out to assess the compliance with recommended documentation of 697 electronic discharge summaries (eDSs) of oncology inpatients discharged in 2018 from the Canberra Hospital according to the National Guidelines of On‐Screen Presentation of Discharge Summaries.Methods and resultsIndividual medical records were identified and screened for the recommended eDS components according to the National Guidelines. Out of the 17 recommended components, nine components were included in all discharge summaries, two components in more than 99% and two components in 95–96% of discharge summaries. The most frequently omitted components include “information provided to the patient,” “ceased medicine” and “procedures,” and these were omitted in 8, 38 and 82% of discharge summaries, respectively.ConclusionOverall, most discharge summaries adhered to the national guidelines quite well by including most of the recommended components. However, the discharge summary quality is still inadequate in some domains.

69 Continuous and Regular Live Feedback is Required to Maintain An Improvement in the Quality of Discharge Summaries. Shop 75 +

Abstract Background This quality improvement project aims to improve communication between secondary and primary care at the time of hospital discharge of older patients. Introduction Discharge summaries (DS) are a key component of communication between secondary and primary care. Poor quality DS are associated with poorer outcomes in terms of adverse events [1], readmissions [2] and medication errors [3]. There is NICE and AMRC guidance on what constitutes a good DS [4, 5]. Method Prospective review of DS from a range of wards was completed in August 2017 against a detailed data tool. A random selection of DS from the same wards was audited monthly from November 2017 onwards. A novel live-feedback system was introduced to the same wards in February 2018 so that the teams completing DS received feedback on how well their summaries complied with the recommendations and what areas needed improvement. A change in staffing lead to a break in the delivery of monthly feedback to the ward teams from April to September 2019 when it was re-commenced. Results In the majority of areas there has been an increase in the quality of the DS from the beginning of the project until March 2019 when the regular feedback interventions were suspended. There was a decrease in the quality of summaries in July and August 2019, followed by an increase as regular feedback interventions recommenced in September 2019. The aggregate results of the four main components of DS (follow-up actions, medicines, clinical summary, and functional assessment), scored “good” in 13% of DS at baseline, 40% in March 2019, 20% in July 2019 and 31% in October 2019. Conclusions The suspension of regular direct interventions resulted in a significant deterioration in the quality of discharge summaries, and this improved quickly after reintroduction of PDSA cycles in key areas. Continuous quality improvement requires uninterrupted focus on regular live feedback.

50 Using A Targeted Teaching Intervention to Drive up the Quality of Discharge Summaries. Shop 75+

Abstract Background Quality improvement project examining discharge communication, and a targeted teaching intervention. Introduction Poor quality, incomplete or missing discharge summaries (DSs) are associated with avoidable/ameliorable adverse events after discharge [1]; preventable readmission [2,3]; failure to implement discharge plans [4]; and medication continuity errors [4,5]. Methods To review the quality of DSs produced, each month forty representative DSs are randomly selected from four clinical areas and qualitatively assessed (total &amp;gt; 1,000, August 2017—to date). Alongside this, in August 2018, incoming foundation doctors were surveyed on perceptions of the purpose/importance of DSs, and training provided on writing them. They were resurveyed after teaching delivery in November 2018 and April 2019. Interventions Data from QI review and survey were used to generate a teaching intervention, in the form of an interactive slide set for delivery in small group settings. This was delivered in weekly mandatory teaching sessions. PDSA cycles were completed for teaching sessions, and the slide set was developed accordingly. Results After the teaching sessions, we noted improvement in satisfaction with training provided on writing DSs (from 24% to 40%), as well as confidence in writing high-quality DSs (from 28% to 100%). We demonstrated increases in responses including the patient as an intended audience for the DS (from 51% to 84%), and rating “patient information in lay terms” of “high importance” (from 41% to 72%). These changes in perceptions were accompanied by improvement in the quality of DSs produced, particularly with respect to the quality of follow-up actions detailed and the quality of patient information provided in lay terminology. The average monthly proportion of DSs achieving a “great score” in these areas increased from 20% and 28% respectively (August 2017—June 2018), to 44% and 71% (August 2018—March 2019). Conclusions These data provide proof-of-principle that targeted teaching, constructed around prior questionnaire surveys, improves awareness of the purpose of DCs and leads to improvement in the quality of DSs produced and enhanced patient safety.