Improve your discharge summary with this advice
Keep it short and sweet
Discharge summaries should be written for the purpose of being read and understood.
If hospital physicians write with this goal in mind, then discharge communication will improve.
"The rationale behind doing a quality discharge summary and handoff is that bad ones can lead to diagnostic errors or misconceptions down the road," Jennifer S. Myers, MD, assistant professor of clinical medicine and patient safety officer at the Hospital of the University of Pennsylvania in Philadelphia. Myers spoke about teaching safe transitions at the 2009 Annual Meeting of the Hospital Medicine Association, held May 14-17, 2009, in Chicago.
"There are more and more regulatory mandates to standardize discharge communication," Myers says.
For example, the handoff and medication Reconciliation National Patient Safety Goals of The Joint Commission recommends that each patient case should involve verbal communication from the inpatient to outpatient provider. Also, all patients should receive updated medication lists sent to their community providers, Myers says.
"One marker of readmission is how good or bad was the discharge," she explains. "Was the patient ready to go home? Did the patient have home care arranged? Did we make sure the patient had access to the medications prescribed?"
All of these issues need to be addressed in a discharge summary.
A quality summary is considered to be one that is organized, succinct, internally consistent, and easy to read, as well as containing all of the essential discharge summary components.1
Myers teaches physicians how to write a good discharge summary, detailing the key components, common pitfalls, and guiding principals.
"At Penn, a few years ago, we published a paper based on educational curricula around discharge summaries, and now we're working on educational research to improve inpatient hand-offs," Myers says. "We would like to help other hospitalists teach these concepts as skills."
The study found that interns who were instructed on how to improve their discharge summary skills wrote better discharge summaries.1
Medical interns who were in the curriculum arm received lectures on discharge summary writing skills. Others in the curriculum plus feedback arm received the lectures plus feedback on discharge summaries they had written.1
"Physician interns often make their discharge summaries lengthy, and it's difficult to find the important information," Myers says.
A nine-item discharge summary evaluation tool (DSET) was used to individually review and grade the discharge summaries written by interns during the study period. The tool assessed for the presence of discharge summary elements required by The Joint Commission, and it assessed the overall quality of the summary.1
Both intervention groups showed overall improvement in quality after the educational intervention, while the control group showed significant improvement only in one area.1
The key is to ask yourself this question: "Would I want to be on the receiving end of this discharge summary?" Myers says. "Is the summary accurate, organized, and readable?"
Reference
1. Myers JS, Jaipaul K, Kogan JR, et al. Are discharge summaries teachable? The effects of a discharge summary curriculum on the quality of discharge summaries in an internal medicine residency program. Acad Med. 2006;81(10):55-58.
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