Background:
The time of hospital discharge is a pivotal period in the care of hospitalized patients and one during which patients are at particular risk for adverse events. This is especially true for patients with heart failure who often have multiple comorbidities and are on multiple medications, the doses of which are dependent on the patient's current status. There has been little research concerning the best ways to improve communication around the inpatient‐to‐outpatient transition. In particular, there are few good models to teach resident house staff. who are predominantly responsible for the completion of discharge information in academic medical centers, about writing concise yet complete discharge instructions and discharge summaries or how computerized physician order entry systems could be used to improve the quality and efficiency of the discharge process through the introduction of decision support and templates for documentation.
Methods:
A before‐and‐after study design was used to assess the effect of our intervention, which included a didactic session for interns and residents starting notations on inpatient general medicine and cardiology services at an academic medical center, during which the key elements to be included for discharge instructions and discharge summaries for patients with heart failure were reviewed and a standardized template for completing discharge documentation for patients with heart failure was introduced. Admission diagnoses were screened and inpatient charts were reviewed to identify admissions where heart failure was an active condition. Patients who died during the hospitalization were excluded from the study. The percentage of key elements included in the discharge documentation was measured as the primary outcome. Secondary outcomes included patient readmisston rates, outpatient care provider satisfaction with discharge documentation, and intern/resident self‐reported efficiency of completing and quality of their discharge documentation
Results:
Discharge documentation from 60 admissions during the pretntervention and 47 admissions during the postintervention period were reviewed. The heart failure discharge template was used for 45% of discharge instructions and 30% of discharge summaries during the postintervention period. The intervention resulted in an overall increase in the inclusion of key elements in the discharge instructions from 61% to 60% and in the discharge summary from 61% to 72%. Use of the template was associated with a significant increase in the inclusion of key elements in both the discharge instructions and discharge summary, to 97% and 95%, respectively.
Conclusions:
Standardized templates are an effective means of improving the quality of discharge documentation for patients with heart failure and can improve compliance with required quality measures.
Author Disclosure:
R. Boxer, none; J. Schnipper, none; E. Gandara, none.