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

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Yagmur Esemen ◽  
Micaela Uberti ◽  
Navneet Singh ◽  
Andreas Karamitros
Keyword(s):  
Formal Education ◽  
Discharge Summary ◽  
Ward Round ◽  
Junior Doctors ◽  
Care Providers ◽  
Essential Components ◽  
Visual Aid ◽  
Primary Means ◽  
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.

scholarly journals 1364 Quality Control of Discharge Summaries for Endocrine Surgery Patients; A Closed Loop Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Karageorgou ◽  
M Hanna ◽  
S Calvosa ◽  
A Fayaz ◽  
I Christakis
Keyword(s):  
Medical Training ◽  
Correct Diagnosis ◽  
Discharge Summary ◽  
Surgical Patients ◽  
Endocrine Surgery ◽  
Junior Doctors ◽  
City Hospital ◽  
Clinical Coding ◽  
Discharge Summaries

Abstract Aim A patient's discharge summary (TTO) should be accurate. Most of them are conducted by junior doctors at the beginning of their medical training. The information mentioned in a TTO ensures patient safety, continuity of care as well as correct clinical coding for the NHS. Therefore, a re-audit was designed to check the quality of the discharge summaries of endocrine surgical patients In Nottingham City Hospital i.e., the type of operation, diagnosis, or postoperative instructions. Method The first cycle included all the TTOs for the endocrine surgical patients operated from April 2018 to November 2018. Then we re-audited those who had endocrine surgeries from April 2019 to November 2019. NOTIS e-TTO, Bluespier theatre lists and Medway were used to retrieve the data. All general surgery patients were excluded. Results 142 and 104 patients TTOs were included in each audit cycle, respectively. Type of operation was improved from 84% to 95% in the second cycle. Correct diagnosis was reported from 68% to 72% in the second cycle audit. Conclusions The introduction of electronic operation notes in our practice improved the correct clinical coding for the type of operation mentioned in the TTO. The accuracy of correct diagnosis remains suboptimal. Therefore, education of junior doctors and an idea of double-checking from a more senior colleague should be assessed.

scholarly journals Reaching the summit of discharge summaries: a quality improvement project

2021 ◽  
Vol 10 (1) ◽  
pp. e001142
Author(s):  
Richard Thomas Richmond ◽  
Isobel Joy McFadzean ◽  
Pramodh Vallabhaneni
Keyword(s):  
Quality Improvement ◽  
Health And Safety ◽  
Improve Patient Care ◽  
Discharge Summary ◽  
Shop Floor ◽  
Junior Doctors ◽  
Improvement Project ◽  
Step Model ◽  
Assessment Unit ◽  
Discharge Summaries

BackgroundDischarge summaries need to be completed in a timely manner, to improve communication between primary and secondary care, and evidence suggests that delays in discharge summary completion can lead to patient harm.Following a hospital health and safety review due to the sheer backlog of notes in the doctor’s room and wards, urgent action had to be undertaken to improve the discharge summary completion process at our hospital’s paediatric assessment unit. It was felt that the process would best be carried out within a quality improvement (QI) project.MethodsKotter’s ‘eight-step model for change’ was implemented in this QI project with the aim to clear the existing backlog of pending discharge summaries and improve the timeliness of discharge summary completion from the hospital’s paediatric assessment unit. A minimum target of 10% improvement in the completion rate of discharge summaries was set as the primary goal of the project.ResultsFollowing the implementation of the QI processes, we were able to clear the backlog of discharge summaries within 9 months. We improved completion within 24 hours, from <10% to 84%, within 2 months. The success of our project lies in the sustainability of the change process; to date we have consistently achieved the target completion rates since the inception of the project. As a result of the project, we were able to modify the junior doctor rota to remove discharge summary duty slots and bolster workforce on the shop floor. This is still evident in November 2020, with consistently improved discharge summary rates.ConclusionQI projects when conducted successfully can be used to improve patient care, as well as reduce administrative burden on junior doctors. Our QI project is an example of how Kotter’s eight-step model for change can be applied to clinical practice.

Independent Prescribing Pharmacists Supporting the Early Discharge of Patients Through Completion of Medical Discharge Summaries

2018 ◽  
Vol 33 (2) ◽  
pp. 173-175 ◽  
Author(s):  
Martin J. Biggs ◽  
Timothy C. Biggs
Keyword(s):  
Hospital Discharge ◽  
Medication Errors ◽  
Early Discharge ◽  
Discharge Summary ◽  
Medical Decision ◽  
Junior Doctors ◽  
Allied Health Professionals ◽  
Independent Prescribing ◽  
Discharge Summaries ◽  
Improve Service Delivery

Purpose: Independent prescribing pharmacists are able to independently prescribe medications following additional postgraduate training. This study examined their use in completing medical discharge summaries, normally completed by junior doctors, in order to assess their impact on expedited hospital discharge times. Methods: In total, 163 patients were studied through a 2-stage audit. The first cycle evaluated junior doctors completing medical discharge summaries (as is normal practice). Three independent prescribing pharmacists were then trained to complete discharge summaries, and a second cycle was completed. Results: Following implementation of independent prescribing pharmacists to complete medical discharge summaries, the time from medical decision to discharge to summary completion dropped significantly (mean of 2:42 hours to 1:35 hours, P < .001). The time from medical decision to discharge to actual hospital discharge also dropped significantly (mean of 5:21 hours to 3:58 hours, P < .01). The number of discharge summary medication errors dropped significantly ( P < .05) between audit cycles. Conclusion: The introduction of independent prescribing pharmacists to complete medical discharge summaries has significantly reduced the time to summary completion, discharge time, and the number of medication errors. In a time of limited medical resources and bed shortages, the use of allied health professionals to improve service delivery is of paramount importance. This project is the first of its kind within the literature.

scholarly journals A Structured Workshop to Improve the Quality of Resident Discharge Summaries

2012 ◽  
Vol 4 (1) ◽  
pp. 87-91 ◽  
Author(s):  
Jaideep S. Talwalkar ◽  
Jason R. Ouellette ◽  
Shawnette Alston ◽  
Gregory K. Buller ◽  
Daniel Cottrell ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Discharge Summary ◽  
Faculty Members ◽  
Evaluation Tool ◽  
Outpatient Physician ◽  
Hospital Discharge Summary ◽  
Structured Program ◽  
Discharge Summaries

Abstract Background Poor communication at hospital discharge can increase the risk of adverse events. The hospital discharge summary is the most common tool for detailing events related to hospitalization in preparation for postdischarge follow-up, yet deficiencies in discharge summaries have been widely reported. Resident physicians are expected to dictate discharge summaries but receive little formal training in this arena. We hypothesized that implementation of an educational program on chart documentation skills would result in improvements in the quality of hospital discharge summaries in a community hospital internal medicine residency program. Methods A monthly, 1-hour workshop was launched in August 2007 to provide consistent and ongoing instruction on chart documentation. Guided by a faculty moderator, residents reviewed 2 randomly selected peer chart notes per session using instruments developed for that purpose. After the workshop had been in place for 2 years, 4 faculty members reviewed 63 randomly selected discharge summaries from spring 2007, spring 2008, and spring 2009 using a 14-item evaluation tool. Results Mean scores for 10 of the 14 individual items improved in a stepwise manner during the 3 years of the study. Items related to overall quality of the discharge summary showed statistically significant improvement, as did the portion of the summaries “carbon copied” to the responsible outpatient physician. Conclusions The quality of hospital discharge summaries improved following the implementation of a novel, structured program to teach chart documentation skills. Ongoing improvement was seen 1 and 2 years into the program, suggesting that continuing instruction in those skills was beneficial.

Analysis of an intervention on discharge summary quality and timeliness

2015 ◽  
Vol 3 (3) ◽  
pp. 362 ◽  
Author(s):  
Natalie Rose Mourra ◽  
Jason S Fish ◽  
Michael Adam Pfeffer
Keyword(s):  
Hospital Discharge ◽  
Discharge Summary ◽  
Monetary Incentive ◽  
Regression Modeling ◽  
Improvement Project ◽  
Patient Demographics ◽  
Time To Completion ◽  
The Impact ◽  
Discharge Summaries

Objective: Deficits in communication between inpatient and outpatient physicians in the post-hospital discharge period are common and potentially detrimental to person-centered doctor-patient relationships and to patient health. This study assesses the impact of a hospital discharge improvement project implemented at an urban academic hospital, aimed at improving the timeliness and quality of discharge summaries using a standardized discharge template, education and a small monetary incentive. Methods: A random sample of 624 charts from an academic, urban hospitalist medicine service was analyzed from the pre- and post-project implementation time periods: 2009-2010 and 2010-2011. The sampling was evenly distributed throughout the months of the year. Ordinary linear regression modeling was used to evaluate the impact of the intervention on time to completion; logistic regression modeling was used to assess the impact on the quality of the discharge summaries. Both models control for patient characteristics, hospitalization acuity and in-hospital continuity of care.Results: Unadjusted time to discharge summary completion rates decreased by 2.4 days (p<0.001) between the pre- and post-implementation times. Controlling for patient demographics, acuity of hospitalization and hand-offs between physicians, time to completion of discharge summaries was decreased by 2.17 days (p< 0.001). The odds of including at least 50% of the recommended information into a discharge summary post-intervention was 6.44 (p<0.001) compared to the odds before the intervention, controlling for patient demographics, acuity of hospitalization and hand-offs between physicians. Conclusion: The use of education, a simple formatted recommended discharge template and a small monetary incentive improved both the timeliness and quality of the information exchanged between inpatient and outpatient providers and contributes significantly to a person-centered healthcare.

Discharge summaries for patients undergoing acute scrotal exploration: Are we providing accurate essential information?

2016 ◽  
Vol 10 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Piyush B Sarmah ◽  
Raghuram Devarajan
Keyword(s):  
Testicular Torsion ◽  
Operative Procedure ◽  
Discharge Summary ◽  
Junior Doctors ◽  
Essential Information ◽  
Testicular Pain ◽  
Operative Findings ◽  
Medical Document ◽  
Discharge Summaries

Objective: To investigate the accuracy of electronic discharge summaries (EDSs) written for patients who had undergone acute scrotal exploration for suspected testicular torsion. Methods: We reviewed the operation notes and EDSs for 169 admissions over a 52-month period where patients had undergone acute scrotal exploration for suspected acute testicular torsion and reviewed the correlation between what was written in these documents, focusing on laterality of pain, operative findings and procedure performed. Results: We found that the side of testicular pain was not mentioned in 14.8% of EDSs, the operative findings recorded on the EDS did not correlate to those on the operation notes in 17.2% of cases and the overall procedure performed did not correlate in 35.5% (with most of these relating to the laterality of the operation). The fact that an operative procedure happened at all was not mentioned in 4.7% ( n = 8) of the EDSs. Conclusions: The information in such an important medical document needs to be accurate, and we advocate that the person performing the operation should initiate the discharge summary process, where EDS use is the norm for discharge. Junior doctors entering urology departments must also be trained on the key information to be included in urological EDSs.

Discharge communication from inpatient care: an audit of written medical discharge summary procedure against the new National Health Service Standard for clinical handover

2015 ◽  
Vol 39 (2) ◽  
pp. 197 ◽  
Author(s):  
Daniel Brooks Reid ◽  
Shaun R. Parsons ◽  
Stephen D. Gill ◽  
Andrew J. Hughes
Keyword(s):  
Health Service ◽  
Discharge Summary ◽  
Junior Doctors ◽  
Department Heads ◽  
Clinical Handover ◽  
Staff Members ◽  
Quality Health ◽  
Service Standards ◽  
Discharge Summaries ◽  
Summary Procedure

Objective To audit written medical discharge summary procedure and practice against Standard Six (clinical handover) of the Australian National Safety and Quality Health Service Standards at a major regional Victorian health service. Methods Department heads were invited to complete a questionnaire about departmental discharge summary practices. Results Twenty-seven (82%) department heads completed the questionnaire. Seven (26%) departments had a documented discharge summary procedure. Fourteen (52%) departments monitored discharge summary completion and 13 (48%) departments monitored the timeliness of completion. Seven (26%) departments informed the patient of the content of the discharge summary and six (22%) departments provided the patient with a copy. Seven (26%) departments provided training for staff members on how to complete discharge summaries. Completing discharge summaries was usually delegated to the medical intern. Conclusions The introduction of the National Service Standards prompted an organisation-wide audit of discharge summary practices against the external criterion. There was substantial variation in the organisation’s practices. The Standards and the current audit results highlight an opportunity for the organisation to enhance and standardise discharge summary practices and improve communication with general practice. What is known about the topic? The Australian National Safety and Quality Health Service Standards (Standard 6) require health service organisations to implement documented systems that support structured and effective clinical handover. Discharge summaries are an important and often the only form of communication during a patient’s transition from hospital to the community. Incomplete, inaccurate and unavailable discharge summaries are common and expose patients to greater health risks. Junior staff members find completing discharge summaries difficult and fail to receive appropriate education or support. There is little published evidence regarding the discharge summary practices of inpatient health services. What does this paper add? The paper demonstrates that there is substantial variation in practice regarding discharge summaries in a large regional health service. Departments have different processes and vary in the degree of attention and quality assurance provided to discharge summaries. Variable organisation procedures make completing discharge summaries more difficult for junior doctors, who regularly move between departments. Variable practice is likely to increase the risk of absent, untimely, incomplete or incorrect communication between acute and community services, thereby reducing the quality of patient care. It is likely that similar findings would be found in other hospitals. What are the implications for practitioners? To be accredited under the National Safety and Quality Health Service Standards, health organisations must ensure that adequate processes are in place for safe and effective clinical handover. Organisations should reduce the practice variability by standardising processes, monitoring compliance with processes, and training and supporting junior doctors.

scholarly journals Improving driving advice provided to cardiology patients on discharge

2018 ◽  
Vol 7 (1) ◽  
pp. e000162
Author(s):  
Amoolya Vusirikala ◽  
Mark Backhouse ◽  
Sarah Schimansky
Keyword(s):  
Hard Copy ◽  
Junior Doctors ◽  
Improvement Project ◽  
The Third ◽  
Driving Restrictions ◽  
Pdsa Cycle ◽  
Before And After ◽  
Ability To Drive ◽  
Discharge Summaries

Certain cardiac conditions can limit patients’ ability to drive. It remains the doctors' responsibility to advise patients of any driving restrictions and is particularly important after certain diagnoses or procedures. We identified that the quality of documented advice was variable and frequently no written driving advice was recorded on discharge. It was apparent that there was a lack of awareness and knowledge of the current Driving and Vehicle Licensing Agency (DVLA) guidance among junior doctors.We therefore designed a quality improvement project using Plan–Do–Study–Act (PDSA) methodology to improve the provision of driving advice on discharge from a cardiology ward by focusing on staff education. After collecting baseline data, we created a template with cardiology-specific DVLA advice. During the second PDSA cycle, we improved the electronic template and also introduced a hard copy on the ward. During the third PDSA cycle, we incorporated information on DVLA guidance in the specialty induction session. We also evaluated junior doctors’ confidence of providing driving advice before and after this intervention.Baseline measurements showed that 10% (9/92) of all discharge summaries included driving advice. This improved to 49% (34/69) after the third PDSA cycle. Importantly, after receiving information on driving advice in the induction, junior doctors felt more confident in providing driving advice to cardiology patients on discharge. In conclusion, the provision of driving advice on discharge is an important element of patient safety. However, clinicians’ knowledge and awareness of current DVLA guidance is often limited. We demonstrated a significant increase in the provision of driving advice by introducing a standardised template.

Quality of psychiatric discharge summaries: a service evaluation following the introduction of an electronic discharge summary system

2015 ◽  
Vol 32 (4) ◽  
pp. 327-330 ◽  
Author(s):  
M. Abbas ◽  
T. Ward ◽  
M. H. Peivandi ◽  
E. McKenzie ◽  
K. Kujawska-Debiec ◽  
...  
Keyword(s):  
Clinical Information ◽  
Electronic System ◽  
Discharge Summary ◽  
Service Evaluation ◽  
Before And After ◽  
Drug History ◽  
Icd 10 ◽  
Electronic Discharge Summary ◽  
Discharge Summaries

BackgroundThere has been a recent move in psychiatry towards the use of electronic discharge (e-discharge) summaries in an effort to improve the efficiency of communication between primary and secondary care, but there are little data on how this affects the quality of information exchanged.ObjectiveTo evaluate the quality of psychiatric discharge summaries before and after the introduction of the e-discharge summary system.MethodsA retrospective analysis of 50 dictated discharge summaries from 1 January to 1 July 2010 and of 50 e-discharge summaries from 1 January to 1 July 2012, evaluating for the inclusion of 15 key items of clinical information.ResultsThe average total score of the dictated summaries (mean=9.5, s.d.=2.0) was significantly higher (p<0.001) than the e-discharge summaries (mean=6.7, s.d.=1.8). There were statistically significant differences in five of the standards: findings of physical examination (p<0.001), ICD-10 code (p<0.001), forensic history (p<0.001), alcohol history (p<0.001) and drug history (p<0.001).ConclusionOur results revealed a decline in the quality of discharge summaries following the introduction of an electronic system. The reasons for this are unclear and require further analysis. Specific suggestions will depend on the local need, but include improvements in software design and layout as well as better education and training.

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