The discharge summary is critical to safe transitions from the inpatient to the outpatient setting. However, there are few educational models on how best to teach those on the house staff, who write most discharge summaries in academic medical centers, to write concise yet complete discharge summaries.
The goals of the study were to improve the quality of discharge summaries by piloting an intern educational curriculum and to measure the impact of the curriculum by surveying interns and objectively evaluating discharge summaries using explicit criteria.
In July 2005 senior residents led a 1‐hour small‐group session on transitions of care. The case‐based discussion focused on the key elements and organization of an effective discharge summary as described in a national workshop on ideal hospital discharges.
Interns were surveyed prior to the curriculum regarding the frequency with which they included certain elements of discharge summaries and immediately after the curriculum regarding what they had learned. To measure the durable effects of the intervention, 3 physicians explicitly reviewed a sample of discharge summaries written by end‐of‐year interns in June 2005, prior to the new curriculum, and again in June 2006. Results were dichotomized and analyzed using Fisher's exact test.
Only 47% of the interns surveyed reported having received prior instruction on how to complete a discharge summary. Only 38% reported always writing a summarized (as opposed to complete) version of the admission history and physical. Only 56% reported always including medication changes in their discharge summaries. Postsession surveys showed that the 2 most common lessons learned were: (1) the importance of writing concise discharge summaries containing information pertinent to continuing care and (2) including preadmission medications and highlighting medication changes at discharge.
Of the 28 metrics evaluated in the review of 80 discharge summaries, 2 were found to be statistically different after the intervention compared with baseline: pertinent admission history and physical succinctly stated (80% vs. 58%, P = .05) and preadmission and discharge medications documented (72% vs. 36% P = .002). No changes were found in the other metrics, including documentation of clinical status at discharge and PCP follow‐up plan. Overall, 50% vs. 56% (P = .66) of summaries reviewed met criteria for being of high or very high quality.
A focused educational curriculum led to improvements in certain key metrics, but overall the quality of discharge summaries did not change. Areas for improvement include emphasis on clinical status at discharge and specific follow‐up plans. A focused intern educational session is helpful, but improving the quality of discharge summaries will likely require additional interventions, including ongoing individualized feedback.
N. S. Mohta, None; E. Barksy, None; P. Vaishnava, None; R. Ishizawar, None; J. Schnipper, None.
To cite this abstract:Mohta N, Barksy E, Vaishnava P, Ishizawar R, Schnipper J. Effects of an Intern Curriculum on the Quality of Hospital Discharge Summaries. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 91. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/effects-of-an-intern-curriculum-on-the-quality-of-hospital-discharge-summaries/. Accessed November 18, 2019.