Background:
Effective communication among physicians during the hospital discharge process is critical to patient care. Since 2004 the Joint Commission has provided a set of necessary information to be included in all discharge documentation. Beyond this minimum data set, other data elements are likely necessary as well (e.g., information about medication reconciliation). As a consequence, Partners Healthcare has been engaged in a multiyear process to measure and improve the quality of documentation of all patients discharged to subacute facilities from its 5 acute care hospitals.
Methods:
Partners first engaged stakeholders to develop a consensus set of 12 required data elements for all discharges to subacute facilities. A measurement process was then established: discharge documentation packets (including discharge summaries, discharge orders, and nursing instructions) from 50 selected patients were reviewed from each hospital per quarter. Quality improvement interventions were then initiated to address measured deficiencies and included: (1) technological improvements to hospitals' discharge ordering systems to actively solicit and/or autoimport required information into discharge documentation, (2) creation of discharge templates to record required information on paper, (3) provision of feedback to clinicians and their service chiefs regarding the ongoing quality of their discharge documentation, (4) educational initiatives targeted at responsible providers, and (5) reviews of documentation by nurse care coordinators prior to discharge. To measure improvement in quality as a result of these efforts, rates of inclusion of each data element and simultaneous inclusion of all 12 applicable data elements (defect‐free rate) were analyzed over time using the chi‐square test for trend.
Results:
We retrospectively studied 3101 discharge documentation packets of patients discharged to subacute facilities from January 1, 2006, through September 2008. During the 11 monitored quarters, the defect‐free rate increased from 65% to 96% (P < 0.001 for trend). The largest improvements were seen in documentation of preadmission medication lists, allergies, follow‐up, and warfarin information (Table 1).
Table 1. Quality of Discharge Documentation Over Time
Conclusions:
Institution of a rigorous measurement, feedback, and multidisciplinary, multimodal quality improvement process successfully improved the inclusion of data elements in discharge documentation required for safe hospital discharge across a large integrated health care system
Author Disclosure:
E. Gandara, none; T. Moniz, none; J. Ungar, none; L. Lee, none; M. Chan‐Macrae, none; T. O'Malley, none; J. L. Schnipper, none.