Background: A hospital discharge summary serves as an important document that outlines the patient’s hospital course, changes made to their medication regimen, and significant studies or events that took place during their stay. Studies have shown that high-quality discharge summaries are instrumental in facilitating safe transitions from the hospital, minimizing adverse events, and reducing hospital readmissions. Patients can be adversely affected because of delayed, incorrect or incomplete discharge summaries. Lack of proper communication or information in discharge summaries lends to increased risk of re-hospitalization, complications due to medication error, morbidity and mortality. Our goal was to improve discharge summaries by understanding the gap between inpatient and outpatient provider perspectives.
Methods: In 2018, our institution conducted a multi-center, multispecialty survey that assessed outpatient providers’ preferences and perspectives on discharge summaries. We then formulated a standardized discharge summary template based on what outpatient providers believed were the crucial elements of documentation. In September 2022, another multisite, multispecialty survey was conducted within our healthcare system to further assess both inpatient and outpatient providers’ perspectives on content and style choices in discharge summaries. We analyzed the data qualitatively with subsequent visualization using a heat map.
Results: A total of 244 participants were surveyed of which 162/244 (66.4%) were attendings, 28/244 (11.5%) were advanced practice providers (APPs), 1/244 (0.4%) were fellows, and 53/244 (21.7%) were residents. Participants were also stratified into 12/244 (4.9%) critical care medicine, 54/244 (21.7%) emergency medicine, 29/244 (11.9%) family medicine, 73/244 (29.9%) hospital medicine, 75/244 (30.7%) internal medicine, and 1/244 (0.4%) medicine-pediatric medicine specialties. Overall, providers had similar opinions regarding the most and least important areas of the discharge summary regardless of specialty or training level. This is depicted in the heat map shown in Figure 1, which demonstrates a ranking prioritization of discharge diagnosis and hospital course. Interestingly, family practice physicians felt (in order of descending importance) the discharge diagnosis, medications, and hospital course to be most salient; whereas hospital and internal medicine practitioners felt the hospital course was the most important, followed by follow-up items, discharge diagnosis, and then medications. Between provider types, residents tended to disagree with attendings and APPs, prioritizing follow-up items first while the latter ranked discharge diagnosis and hospital course higher. In reviewing the free-response suggestions, the most frequently discussed area for improvement was delineation of medications. The second category of most mentioned items included discharge summary content, which centered on discharge diagnoses and hospital course.
Conclusions: Hospital discharge documentation is crucial to continuity of patient care. Our project suggests that understanding priorities for each specialty may improve communication between providers and improve discharge documentation overall. There seemed to be congruencies among specialties and level of training which indicate that standardized template would fit the desires of multiple inpatient and outpatient providers.
