Background:
The Center for Medicaid and Medicare Services requires that a discharge summary be completed only within 30 days of discharge. This rule is inadequate to ensure safe care transitions, as outpatient physicians must receive more timely information regarding a patient's hospital course. We describe the implementation of an electronic discharge summary (EDCS) and report preliminary data on discharge summary quality and timeliness compared with standard dictated summaries.
Methods:
The EDCS, a note template completed through the use of checkboxes and imported data balanced with free text, was introduced to all medicine teams in October 2010. To promote efficiency, the note was designed to serve both as the discharge summary and as the last day's progress note and appeared instantly in the electronic medical record. Residents were incentivized to complete the EDCS on the day of discharge, and attendings were instructed to finalize it within 48 hours of discharge. Time of discharge summary completion and finalization were analyzed for a 3‐month period prior to implementation of EDCS and for 2 months after. Eighty randomly selected discharge summaries completed before and after the intervention were manually audited for quality, defined as completion of recommended fields (reason for admission, hospital course, significant findings, discharge instructions, discharge diet and activity, discharge medications, pending tests, follow‐up plans, and discharge diagnosis).
Results:
Five hundred and sixty‐three discharge summaries were completed during a 3‐month period prior to EDCS implementation compared wth 509 in the 2 months after. Adoption of EDCS use was high, with 490 (96%) of 509 discharge summaries using the EDCS instead of dictation. The average time from discharge to resident completion fell from 4 to 0.53 days (P < 0.001), and the time to attending finalization fell from 9 to 1.48 days (P < 0.001). Prior to the initiation of EDCS, residents completed 38% of discharge summaries on the day of discharge, compared with 77% after the intervention, and attendings finalized 15% of discharge summaries within 48 hours of discharge, compared with 81% after (P < 0.001 for both). Of the 80 discharge summaries audited for quality in the pre‐ and postimplementation periods, completion of recommended elements increased from 46 to 76 (58% vs. 95%, P < 0.001). Seventy‐two EDCS compared with 8 dictated summaries (90% vs. 10%, P < 0.001) included detailed information about medications stopped, new medications started, and old medications continued, and 78 EDCS (98%) mentioned both pending tests and follow‐up plans, compared with 26 summaries (33%) dictated previously (P < 0.001 for both).
Conclusions:
By integrating discharge summary creation into existing resident and attending work flow, we were able to decrease time to discharge summary completion while improving quality.
Disclosures:
M. Mourad ‐ none; R. Cucina ‐ none; S. Ranji ‐ none