Improving Timeliness without Compromising Quality: Discharge Summaries Dictated by Internal Medicine Residents

1Banner Good Samantan Medical Center, Phoenix, AZ
2Banner Good Samaritan Medical Center, Phoenix, AZ
3Banner Good Samaritan Medical Center, Phoenix, AZ

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 91

Background:

The discharge summary is an important tool for communicating essential information as patients transition from the hospital, yet it frequently does not arrive for outpatient physicians in a timely manner Furthermore, residents are often responsible for dictating discharge summaries but receive little instruction in doing so. Delayed availability and poor quality of the discharge summary can contribute to medication errors and other adverse events after discharge. Our institution initiated a process by which summaries are dictated and transcribed prior to patient discharge, Copies of the slat discharge summary are faxed to offices and hand‐carried by patients to their posthospital visits, This was an observational, retrospective study evaluating the effect of this process and an educational intervention on the timeliness and quality of the dictation of discharge summaries by internal medicine residents.

Methods:

Forty‐six discharge summaries dictated by internal medicine residents were evaluated (25 preintervention, 21 postintervention) from December to February during 2 consecutive years. The time and date of discharge were obtained from the hospital computer database, and dictation and transcription times were obtained from the summaries. The time of dictation was categorized as prior to or after discharge In addition to the stat transcription process, the residents received instruction on the importance of concise, complete, and accurate discharge summaries and were given pocket cards containing essential components of the discharge summary. We created an evaluation tool that measures content, conciseness, clarity, and readability of discharge summaries.

Results:

Prior to the intervention, 43% of discharge summaries were dictated by the time of patient discharge compared with 96% after the intervention (P < 0.001). Of the summaries dictated after discharge, 29% of the summaries (n = 6) were dictated more than 28 days after discharge prior to the intervention versus 4% (n = 1) after the intervention (P = 0.036). Differences in quality pre‐ and postintervention using the X2 test were not statistically significant.

Conclusions:

It is during the vulnerable period after hospital discharge that 49% of patients experience at least 1 medical error in medications, diagnostic workup, or test follow‐up, Prior studies have demonstrated that poor communication is the primary reason, and lack of availability of the discharge summary is a major obstacle. Our results demonstrate that the timeliness of a discharge summary can be significantly improved with stat dictation and transcription and incorporation into the discharge process without adversely affecting quality, Although the education component did not improve quality in this small study, we plan to study the effect of a formalized discharge summary curriculum on quality improvement in a larger sample of discharge summaries.

Author Disclosure:

E. Mallin, none; C. O'Malley, none; R. Gerkin, none.

To cite this abstract:

Mallin E, O'Malley C, Gerkin R. Improving Timeliness without Compromising Quality: Discharge Summaries Dictated by Internal Medicine Residents. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 91. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/improving-timeliness-without-compromising-quality-discharge-summaries-dictated-by-internal-medicine-residents/. Accessed September 18, 2019.

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