Background:
High‐quality discharge summaries are a key component of a safe transition in care from the inpatient to the outpatient setting. However, the best ways to incorporate resident training in discharge summary creation into clinical practice in academic medical centers is unknown.
Purpose:
To determine the effects of a “discharge time‐out” on the quality of discharge summaries written by first‐year medical residents.
Description:
We implemented a discharge time‐out (DTO) based on the concept of a “surgical time‐out”, now considered standard of care prior to surgery. During attending rounds, on discussion of a patient scheduled for discharge, the DTO provided a series of questions to be briefly answered by the resident caring for the patient. Concepts addressed included the patient's initial presentation, relevant findings, final diagnosis, treatment, response to treatment, condition on discharge, discharge and follow‐up plan, and contingency planning (i.e., what to watch for after discharge). The goals of the discharge time‐out were severalfold: to focus the medical team on the importance of care transitions, to help residents synthesize the information learned about a patient during the hospitalization, to emphasize the importance of the postdischarge plan (as opposed to the initial presentation), and to provide a framework for creating a concise yet complete discharge summary. As a preliminary evaluation of the effects of the intervention, we conducted an explicit review of 2 randomly selected discharge summaries by each resident prior to receipt of a DTO and compared them to 2 randomly selected discharge summaries by the same resident after receipt of at least 1 DTO. Reviewers were asked to evaluate the inclusion of 28 key discharge metrics. Reviewers were also asked to provide global assessments of discharge summary quality. To adjust for temporal effects, we also evaluated discharge summaries by residents who never received a DTO, matched to the intervention group by month of authorship. We evaluated 40 discharge summaries prior to receipt of a DTO and 40 summaries after receipt. We found several improvements in discharge summaries written afterward compared with temporal controls, including documentation of changes in medications from preadmission to discharge, documentation of a discharge physical examination, tasks to be completed at follow‐up, and global assessments that clinical information was easy to find and that the discharge summary provided specific information providers would need to care for these patients after discharge. However, because of the small sample size, these differences were not statistically significant, and several other measures did not improve.
Conclusions:
Our results suggest that a discharge time‐out, integrated into attending rounds, has the potential to improve discharge summaries and provides an example of an innovative approach to fostering patient safety as a part of usual patient care and educational activities.
Author Disclosure:
P. Vaishnava, none; C. Liang, none; N. Mohta, none; S. Ye, none; M. Vitale, none; J. Schnipper, none.