Improving transitions of care is a quality and patient safety imperative for hospital‐based providers. Inaccurate medication reconciliation during the discharge transition is a known cause of preventable medication errors, patient confusion regarding medication regimens, and primary care provider dissatisfaction.


We hypothesized that the implementation of a multidisciplinary “timeout” focused on medication reconciliation and performed on the day of discharge will detect errors on the discharge medication lists of hospitalized patients.


A “discharge time‐out” was implemented on weekdays on an academic hospitalist service with residents. The time‐out comprised a meeting on the day of discharge between the senior resident, discharging nurse, and clinical pharmacist. During the time‐out, the service providers compared and reconciled the patient's home medication list, inpatient medication list, and discharge medication list. Errors found on the discharge document were corrected in real time. Last, the providers filled out a 6‐item checklist that had been designed by the quality improvement leaders for the project and included items relating to the number and type of medication errors. Over a period of 9 months, a total of 170 errors were identified during 180 discharge time‐outs. The time‐outs comprised 7% of the total discharges. Errors were identified in 68 documents, for an overall rate of approximately 1 error per discharge. For the 68 discharge medication lists that contained any errors, this equates to 2.5 errors per discharge. A variety of medication errors occurred: 50% involved omission of an intended discharge medication, 21% involved the inadvertent inclusion of a medication the medical team had intended for the patient to stop, 20% were errors in medication dosage, 4% were errors in medication duration, and 6% of documents listed an incorrect medication. A total of 7% of the errors involved high‐risk medications such as insulin, sedatives, or warfarin.


Medication errors are extremely common on academic hospitalist services. Our experience indicates that a multidisciplinary review involving a senior resident, nurse, and pharmacist can effectively identify and correct medication errors in the discharge paperwork before they reach our patients. The implementation of this project will generate innovative solutions for improving other critical transitions in care.


I. Lorincz ‐ none; N. Patel ‐ none; S. Schmidt ‐ none; B. A. Boczar ‐ none; J. Savitz ‐ none; V. Ahya ‐ none; J. Rohrbach ‐ none; J. Myers ‐ none