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.

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

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 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.

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 693. Performance of ICD Code Versus Discharge Summary based Query for Endocarditis Cohort Identification

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S448-S448
Author(s):  
H Nina Kim ◽  
Ayushi Gupta ◽  
Kristine F Lan ◽  
Jenell C Stewart ◽  
Shireesha Dhanireddy ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
International Classification Of Diseases ◽  
Discharge Summary ◽  
Admission Diagnosis ◽  
Test Characteristics ◽  
Clinical Narrative ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Icd Codes ◽  
Discharge Summaries

Abstract Background Studies on infective endocarditis (IE) have relied on International Classification of Diseases (ICD) codes to identify cases but few have validated this method which may be prone to misclassification. Examination of clinical narrative data could offer greater accuracy and richness. Methods We evaluated two algorithms for IE identification from 7/1/2015 to 7/31/2019: (1) a standard query of ICD codes for IE (ICD-9: 424.9, 424.91, 424.99, 421.0, 421.1, 421.9, 112.81, 036.42 and ICD-10: I38, I39, I33, I33.9, B37.6 and A39.51) with or without procedure codes for echocardiogram (93303-93356) and (2) a key word, pattern-based text query of discharge summaries (DS) that selected on the term “endocarditis” in fields headed by “Discharge Diagnosis” or “Admission Diagnosis” or similar. Further coding extracted the nature and type of valve and the organism responsible for the IE if present in DS. All identified cases were chart reviewed using pre-specified criteria for true IE. Positive predictive value (PPV) was calculated as the total number of verified cases over the algorithm-selected cases. Sensitivity was the total number of algorithm-matched cases over a final list of 166 independently identified true IE cases from ID and Cardiology services. Specificity was defined using 119 pre-adjudicated non-cases minus the number of algorithm-matched cases over 119. Results The ICD-based query identified 612 individuals from July 2015 to July 2019 who had a hospital billing code for infective endocarditis; of these, 534 also had an echocardiogram. The DS query identified 387 cases. PPV for the DS query was 84.5% (95% confidence interval [CI] 80.6%, 87.8%) compared with 72.4% (95% CI 68.7%, 75.8%) for ICD only and 75.8% (95% CI 72.0%, 79.3%) for ICD + echo queries. Sensitivity was 75.9% for the DS query and 86.8-93.4% for the ICD queries. Specificity was high for all queries &gt;94%. The DS query also yielded valve data (prosthetic, tricuspid, pulmonic, aortic or mitral) in 60% and microbiologic data in 73% of identified cases with an accuracy of 94% and 90% respectively when assessed by chart review. Table 1. Test Characteristics of Three Electronic Health Record Queries for Infective Endocarditis Conclusion Compared to traditional ICD-based queries, text-based queries of discharge summaries have the potential to improve precision of IE case ascertainment and extract key clinical variables. Disclosures All Authors: No reported disclosures

scholarly journals Usability of Clinical Information in Discharge Summary Data in the Diagnosis Procedure Combination Survey for Cancer Patients

2020 ◽  
Vol 17 (2) ◽  
pp. 521
Author(s):  
Ayako Okuyama ◽  
Takahiro Higashi
Keyword(s):  
Missing Values ◽  
Clinical Information ◽  
Cancer Registries ◽  
Discharge Summary ◽  
Data Sets ◽  
Discharge Data ◽  
Diagnosis Procedure Combination ◽  
Summary Data ◽  
Smoking Index

Valid data are required to monitor and measure the quality of cancer treatment. This study aims to assess the usability of diagnosis procedure combination (DPC) survey discharge summary data. DPC survey data were analyzed by linking them to the hospital-based cancer registries (HBCR) from 231 hospitals. We focused on patients who were aged 20 years or older and diagnosed in 2013 with stomach, colorectal, liver, lung, or breast cancer. We assessed the percentage of unknown/missing values in supplementary data for patients with five common cancers and compared DPC cancer stage information to that of HBCR. In total, 279,451 discharge data sets for 180,399 patients were analyzed. The percentages of unknown data for smoking index and height/weight were 10.5% and 2.3%, respectively, and varied from 0.0% to 93.0% between hospitals. In the activity of daily living component, the rates of missing data for climbing stairs (3.6%) and bathing (2.9%) at admission were slightly higher than for other elements. Unexpectedly low concordance rate of tumor, node, and metastasis classification between DPC survey and HBCR data was observed as 80.6%, which means 20.4% of the data showed discrepancies. The usability of DPC survey discharge summary data is generally acceptable, but some variables had substantial amounts of missing values.

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.

scholarly journals A novel inpatient complex pain team: protocol for a mixed-methods evaluation of a single-centre pilot study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019058
Author(s):  
Luke Mordecai ◽  
Cecilia Vindrola-Padros ◽  
Victoria J Wood ◽  
Nicholas Swart ◽  
Stephen Morris ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Best Practice ◽  
Service Evaluation ◽  
Mixed Methods Evaluation ◽  
Before And After ◽  
Ethical Approval ◽  
Poor Outcomes ◽  
Past Experiences ◽  
Compare And Contrast

IntroductionComplex pain is a debilitating condition that is responsible for low quality of life and significant economic impacts. Although best practice in the treatment of complex pain employs a multidisciplinary team, many patients do not have access to this care, leading to poor outcomes.Methods and analysisThis study evaluates a novel inpatient complex pain team at a large London teaching hospital. A multidisciplinary pain team comprising specialist doctors, nurses, psychologists and physiotherapists was instituted for inpatients with complex pain who will undergo an intense and bespoke evidence-based programme which will then be integrated into the community. A mixed-methods evaluation will take place and patients will be recruited over the course of 1 year. A qualitative arm will interview 15 staff and 15 patients on recruitment and again 6 months later looking to compare and contrast the new pain team with past experiences of pain management. A quantitative arm will assess clinical outcomes using validated scoring tools. An economic evaluation will seek to evaluate the relative cost of the service by comparing healthcare costs before and after the intervention.Ethics and disseminationThe study was categorised as a service evaluation, so formal ethical approval was not considered necessary. Participant recruitment began in January 2016 and the 1-year follow-up will end in November 2017. The results of this study will be published in 2018.

scholarly journals EP.TU.79Assessed and Discharged - An Audit of Discharge Summaries Completion During On-Calls

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jennifer Ma ◽  
Bankole Oyewole ◽  
Ajay Belgaumkar
Keyword(s):  
Electronic System ◽  
Discharge Summary ◽  
Professional Communication ◽  
Electronic Records ◽  
Care Provision ◽  
Clinical Note ◽  
Standard Contract ◽  
Improve Compliance ◽  
Effective Health Care ◽  
Discharge Summaries

Abstract Aim Effective health care provision is heavily dependent on timely, reliable transfer of patient information. Failure of this communication between professionals could result in redundancy of tests, delay in treatment, which may in turn endanger patient safety. The NHS Standard Contract requirements state discharge summaries should be completed within 24 hours of hospital assessment and discharge. Discharge summaries for patients who were reviewed but not admitted have been observed to be poorly completed during on-calls and this audit aims to clarify this. Method On-Call Patient Lists between 1 December to 14 December 2020 were studied retrospectively. Patients who were assessed by the on-call surgical team but not admitted were included in the audit. Patients referred to other specialties were excluded. Hospital electronic system was reviewed for electronic records from the encounter including clinical note or discharge summary. Results In total, 47 patients were identified during the 2 week- period. 40/47 patients were referred from AE and 9 of these patients were discharged from AE directly. 3 of the patients had a clinical note or discharge summary completed on the hospital electronic system. Overall, 18 of the 47 (38.3%) patients had a clinical note or discharge summary on the electronic system, with 6 (12.8%) of them being recorded as discharge summaries. Conclusion The overall completion of discharge summaries for this group of patients was poor. Awareness of this failing and the importance of professional communication should be highlighted with the juniors during surgical meeting to improve compliance.

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