scholarly journals Outpatient physicians' satisfaction with discharge summaries and perceived need for an electronic discharge summary

2006 ◽  
Vol 1 (5) ◽  
pp. 317-320 ◽  
Author(s):  
Kevin J. O'Leary ◽  
David M. Liebovitz ◽  
Joseph Feinglass ◽  
David T. Liss ◽  
David W. Baker
Keyword(s):  
Discharge Summary ◽  
Perceived Need ◽  
Electronic Discharge Summary ◽  
Discharge Summaries

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.

Improving Coded Data Entry by an Electronic Patient Record System

1996 ◽  
Vol 35 (02) ◽  
pp. 108-111 ◽  
Author(s):  
F. Puerner ◽  
H. Soltanian ◽  
J. H. Hohnloser
Keyword(s):  
Phase I ◽  
Electronic Patient Record ◽  
Data Entry ◽  
Discharge Summary ◽  
Patient Record ◽  
Phase Iii ◽  
Electronic Patient Record System ◽  
Record System ◽  
Data Encoding ◽  
Discharge Summaries

AbstractData are presented on the use of a browsing and encoding utility to improve coded data entry for an electronic patient record system. Traditional and computerized discharge summaries were compared: during three phases of coding ICD-9 diagnoses phase I, no coding; phase II, manual coding, and phase III, computerized semiautomatic coding. Our data indicate that (1) only 50% of all diagnoses in a discharge summary are encoded manually; (2) using a computerized browsing and encoding utility this percentage may increase by 64%; (3) when forced to encode manually, users may “shift” as much as 84% of relevant diagnoses from the appropriate coding section to other sections thereby “bypassing” the need to encode, this was reduced by up to 41 % with the computerized approach, and (4) computerized encoding can improve completeness of data encoding, from 46 to 100%. We conclude that the use of a computerized browsing and encoding tool can increase data quality and the percentage of documented data. Mechanisms bypassing the need to code can be avoided.

Pain-Prescription Differences - An Analysis of 500,000 Discharge Summaries

2019 ◽  
Vol 11 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Saskia Preissner ◽  
Vishal B. Siramshetty ◽  
Mathias Dunkel ◽  
Paul Steinborn ◽  
Friedrich C. Luft ◽  
...  
Keyword(s):  
Pain Therapy ◽  
Opioid Analgesic ◽  
Developed Countries ◽  
Discharge Summary ◽  
Pain Reliever ◽  
Regulatory Guidelines ◽  
The Usa ◽  
Prescription Rates ◽  
East West ◽  
Discharge Summaries

Background: Pain-relief prescriptions have led to an alarming increase in drug-related abuse. Objective: In this study, we estimate the pain reliever prescription rates at a major German academic hospital center and compare with the nationwide trends from Germany and prescription reports from the USA. Methods: We analysed >500,000 discharge summaries from Charité, encompassing the years 2006 to 2015, and extracted the medications and diagnoses from each discharge summary. Prescription reports from the USA and Germany were collected and compared with the trends at Charité to identify the frequently prescribed pain relievers and their world-wide utilization trends. The average costs of pain therapy were also calculated and compared between the three regions. Results: Metamizole (dipyrone), a non-opioid analgesic, was the most commonly prescribed pain reliever at Charité (59%) and in Germany (23%) while oxycodone (29%), a semi-synthetic opioid, was most commonly ordered in the USA. Surprisingly, metamizole was prescribed to nearly 20% of all patients at Charité, a drug that has been banned for safety reasons (agranulocytosis) in most developed countries including Canada, United Kingdom, and USA. A large number of prospective cases with high risk for agranulocytosis and other side effects were found. The average cost of pain therapy greatly varied between the USA (125.3 EUR) and Charité (17.2 EUR). Conclusion: The choice of pain relievers varies regionally and is often in disagreement with approved indications and regulatory guidelines. A pronounced East-West gradient was observed with metamizole use and the opposite with prescription opioids.

scholarly journals P044 Can an electronic prescribing system ensure clear anticoagulation discharge communication?

2019 ◽  
Vol 104 (7) ◽  
pp. e2.49-e2
Author(s):  
Susie Gage
Keyword(s):  
Patient Safety ◽  
Discharge Summary ◽  
Electronic Prescribing ◽  
List Type ◽  
Heparin Infusion ◽  
National Patient Safety Agency ◽  
High Dependency ◽  
National Patient ◽  
Discharge Summaries

AimThe National Patient Safety Agency (NPSA)1 identified heparin as a major cause of adverse events associated with adverse incidents, including some fatalities. By ensuring good communication, this should be associated with risk reduction.1 The aim of this study was to ensure there is clear anticoagulation communication on discharge, from the paediatric intensive care unit (PICU) electronic prescribing system (Philips), to the paediatric cardiac high dependency unit and paediatric cardiac ward. To investigate whether the heparin regimen complies with the hospital’s anticoagulant guidelines and if there is any deviation; that this is clearly documented. To find out if there is an indication documented for the heparin regimen chosen and if there is a clear long term plan documented for the patient, after heparin cessation.MethodsA report was generated for all patients who were prescribed a heparin infusion on PICU, between 1st January 2018 and 30th June 2018, from the Philips system. All discharge summaries from the PICU Philips system were reviewed. Only paediatric cardiac patients were included that had a heparin infusion prescribed on discharge, all other discharge summaries were excluded from the study. Each discharge summary was reviewed in the anticoagulant section; for the heparin regimen chosen, whether it complies with the hospital’s anticoagulant guidelines and if there was any deviation whether this was documented. The indication documented of which heparin regimen was chosen and whether a clear long term plan was documented after heparin cessation; for example if the patient is to be transferred onto aspirin, clopidogrel, warfarin or enoxaparin.Results82 discharge summaries were reviewed over the 6 month period between 1st January 2018 and 30th June 2018; 16 were excluded as were not paediatric cardiac, leaving 66 paediatric cardiac discharge summaries that were reviewed. 45 out of 66 (68%) complied with the hospital’s heparin anticoagulation guidelines. Of the 32% that deviated from the protocol; only 33% (7 out of 21) had a reason documented. Only 50% (33) of the summaries reviewed had an indication for anticoagulation noted on the discharge summary and 91% of discharge summaries had a long term anticoagulant plan documented.ConclusionThe electronic prescribing system can help to ensure a clear anticoagulation communication as shown by 91% of the anticoagulation long term plan being clearly documented; making it a more seamless patient transfer. On the Philips PICU electronic prescribing system there is an anticoagulant section on the discharge summary that has 3 boxes that need to be completed; heparin regimen, indication and anticoagulation long term plan. However, despite these boxes; deviations from the anticoagulant protocol were poorly documented as highlighted by only 33% having the reason highlighted in the discharge summary, only 50% of the indications were documented. Despite having prompts for this information on the discharge summary, the medical staffs needs to be aware to complete this information, in order to reduce potential medication errors and risk.ReferenceThe National Patient Safety Agency (NPSA). Actions that make anticoagulant therapy safer. NPSA; March 2007.

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 Using an electronic discharge notification system reduces the time delay between discharge and a summary being sent to the GP

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S169-S169
Author(s):  
Alex Adams ◽  
Bodvar Ymisson ◽  
Virginia Davies
Keyword(s):  
Time Delay ◽  
Safety Issue ◽  
Discharge Summary ◽  
Baseline Survey ◽  
Key Factors ◽  
Notification System ◽  
Team Meetings ◽  
Patient Safety Issue ◽  
Technical Issues ◽  
Electronic Discharge Summary

AimsAll patients discharged from our Paediatric Liaison Team will have an electronic discharge summary sent to their GP within 24 hours by January 2020.BackgroundWriting a GP discharge summary is an essential part of patient care and is a patient safety issue if not completed on time. The NHS England Standard Contract states discharge summaries should be completed and sent to a GP within 24 hours of discharge. Baseline data showed our median time between discharge and a GP summary being sent off as 3 days and a baseline survey of staff in our team rated our discharge summary process as inefficient and time consuming. At baseline our discharge summary was typed on a word document which was then emailed to admin staff who would print and post to the GP. Our electronic patient record had an inbuilt discharge notification function that generates and sends summaries via email to the GP that other teams in the trust were already using.MethodWe utilised the Model for Improvement Quality Improvement methodology. Initially we created a driver diagram breaking the process of discharge summary writing into its constituent components to generate change ideas. We then tested out these out in plan, do, study, act (PDSA) cycles whilst continually collecting data using a shared team spreadsheet to monitor for change.ResultWe found that switching to electronically sent discharge notifications improved our time from discharge to a summary being sent to the GP from a median of 3 days to 1 day. We noticed that alongside a shared team spreadsheet monitoring when summaries were written we also reduced variation of time between discharge and a summary from a range of 0-27 days (with an outlier of 161) to 0-9 days.ConclusionOn average the time from discharge to a summary being written met the standard and we reduced the variability of time delay by using an electronic notification. However only 56% of summaries were sent within the 24 hour limit. Key factors for continued variability identified during regular team meetings included overall caseload of patients, amount of staff on shift and technical issues with the form. Our plan for sustainability is to discuss monthly in the team meeting any discharges that took longer than 1 day and target further PDSA cycles to these issues.

scholarly journals ELECTRONIC DISCHARGE SUMMARY DRIVING ADVICE: CURRENT PRACTICE AND FUTURE DIRECTIONS

2013 ◽  
Vol 06 (8) ◽  
Author(s):  
John Carmody ◽  
Michael Carey ◽  
Victoria Traynor ◽  
Don Iverson
Keyword(s):  
Current Practice ◽  
Discharge Summary ◽  
Future Directions ◽  
Electronic Discharge Summary
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