Background:
Poor communication among health providers during transitions of care (TOC) between inpatient and outpatient settings is being increasingly recognized as responsible for subpar health outcomes, wasteful healthcare spending and low patient satisfaction. Such poor communication remains the status quo as it becomes part of the implicit curriculum in residency training when residents are not explicitly engaged in creating well-executed discharge summaries.
Purpose:
A quality improvement (QI) project was conducted through a PDSA cycle that aimed to establish a template to make explicit the essential contents of a discharge summary. A needs assessment was conducted wherein all faculty members at two key teaching clinics were asked “what is the most relevant information for a TOC visit?” A draft template was established based on their responses and the entirety of the program faculty, both inpatient and outpatient, was involved in the discussion and refinement of the template. The finalized template was then distributed and explained to all residents. After the implementation of the template for 2 months, an anonymous survey was conducted among residents and attendings focusing on whether the template had provided sufficient guidance to writing discharge summaries and as a result, higher quality care when patients were followed up for their hospitalizations at clinics.
Description:
The QI project has resulted in a TOC-centered template for writing discharge summaries that directs residents’ attention to the key areas such as change in patients’ overall management (including the reasoning) secondary to their hospitalizations. The later conducted survey confirmed the effectiveness of the QI project. Among 51 residents and attendings who responded to the survey, 68.75% overall agreed that the template had provided clarity and completeness when composing/reviewing discharge summaries. 73.91% of the responders involved in inpatient care at the time of the survey agreed that utilizing the template had increased their efficiency and communication with PCPs. On the outpatient side, 77.08% of the responders agreed that utilizing the template had improved their understanding of patients’ hospital course and facilitated their work on patients’ TOC visits.
Conclusions:
There is wide variation among residents in writing discharge summaries, a critical piece of documentation for transitions of care. By initiating a PDSA cycle to address this issue in place of traditional lecturing, faculty and residents were more actively involved in the learning process. The resultant template not only delineates the items necessary for a well-documented discharge summary but also serves an educational tool for residents to actively identify the key information required for efficient and effective care transitions. The post-implementation survey confirmed the effectiveness of the QI project and also provided a platform for further inputs from residents and attendings.