Background: Hospital discharges represent an important transition of care between the inpatient and outpatient setting. Discharge summary documentation enables providers to convey clinical reasoning and important updates in patient care; however, reviews of these documents suggest error rates as high as 36.4% (1.42 errors per document) (McMillen, et. al. 2006). Formalized resident discharge summary curricula have been shown to improve quality and comfort. The aims of this study were to design a clinical reasoning-based method for teaching and evaluating discharge summary documentation as well as analyzing intern comfort and self-perception of quality of discharge summary before and after the curriculum.
Methods: The curriculum employed two monthly arms to teach high-quality discharge summaries to the writing interns on inpatient rotations and receiving interns on ambulatory blocks. The first arm targeted 81 inpatient interns who attended a didactic presentation outlining the core elements of a discharge summary, including the “4 Ws – What, Why, What happened, What next.” Interns submitted two discharge summaries to be graded by attendings and peers. The evaluation also included open-ended questions for comments and feedback and a checklist to determine inclusion of the “4 Ws.” The second arm of the curriculum involved ambulatory block interns attending a peer review workshop where they graded and discussed take-home points from the summaries. To evaluate resident comfort in writing discharge summaries, pre- and post-surveys were given to ambulatory and inpatient residents at the beginning and end of each session.
Results: Attending physician grades of resident discharge summaries and 4W scoring improved on average by 8.1% and 4.5%, respectively, throughout the year, while peer scoring decreased by 0.86% and 4.96% on average during that same period. Overall resident comfort scores on a Likert scale improved by 6.5% after attending the peer review workshop. Thus far, 2019-2020 data showed a 10.7% increase in comfort level and 14.2% increase in overall quality on average.
Conclusions: Preliminary data from the resident discharge summary curricula shows increased comfort and quality with this type of documentation. We feel that the novelty of this intervention is real-time trainee-to-trainee feedback as well as using ambulatory rotations to help boost clinical reasoning on inpatient rotations.