At our quaternary academic medical center the process of dictating discharge summaries historically led to delays such that discharge summaries were being completed on average of more than 5 days after discharge. Our geriatricians in skilled nursing facilities only “rarely” or “sometimes” received discharge summaries from our hospital. The purpose of this study was to demonstrate that changing the fundamental discharge process enables better timeliness of discharge summary completion as well as forwarding of documents to the next provider.
At our university hospital, we completed discharge summaries via a telephone dictation system, where the resident dictated and the attending signed the dictation with appropriate edits. The interns had also completed a brief typed discharge note that was not routinely reviewed by the resident or the attending. We were seeing both delay in discharge summary completion and incomplete forwarding of documents to both the primary Care provider and the skilled nursing facility. We reengineered the process to eliminate waste and enable completed documentation at the point of care. We did this by eliminating the dictation process for discharge summaries and bolstering the typed discharge note to routinely include data recommended for high quality transitions. Through the electronic medical record (EMR), we cued residents to include items such as recommendations for care to the next provider, identifying tests pending final results at the time of discharge, and core measure requirements for heart failure and pneumonia. We initiated this process into the existing EMR in July 2009. We sent a survey to senior ward residents prior to and after implementation. We recorded baseline data regarding transfer of discharge information to SNF and other facilities via the unit secretary during the month prior to our new process. We instituted a process where the unit secretary would print out the completed discharge summary at the time of actual discharge and transportation to an outside facility (e.g., ambulance arrival). We subsequently collected data in a similar fashion on the success rate of our process.
Our change in process led to an approximately 40% completion by the time residents completed their 4‐week rotation to 100%, which also was complete in more than 80% by the time of discharge. We also demonstrated an improvement in discharge summary inclusion in transfer packets from 10% to more than 80%, Our geriatric faculty verified that discharge summanes were “almost always” included in the ambulance packets.
A simple redesign of our process with completion of discharge summaries using an EMR system as opposed to a dictation system markedly improved the timeliness of discharge summaries being completed, allowed for efficiency in provider work process and facilitated communication to the next provider in the skilled nursing facility.
M. Wang, none; A. Amin, Sanofi Aventis, speaker.
To cite this abstract:Wang M, Amin A. Discharge Summary Redesign Yielding Timely Completion and Forwarding. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 150. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/discharge-summary-redesign-yielding-timely-completion-and-forwarding/. Accessed September 15, 2019.