Use of an Embedded Template Improves Discharge Summary Timeliness

Background:

Patients are at high risk for adverse events following hospital discharge. A discharge summary (DCS) helps to prevent such events but is rarely available to primary care physicians (PCPs) at follow‐up; at our institution, patients often follow up within a day of discharge, whereas internal medicine residents take a mean of 3.0 (July 2007) to 10.3 (February 2007) days to complete the DCS. Our study aimed to determine if embedding the DCS in the discharge instructions (DCI) given to patients at discharge would improve DCS timeliness.

Methods:

We implemented a new template that embedded the DCS in the DCI. Residents on the teaching service at our hospital in September 2007 were encouraged but not required to use this new template in place of the standard DCS and DCI templates; non‐teaching services continued to use the latter. We then reviewed the charts of patients discharged from the teaching and nonteaching general medicine services in September 2007 and compared them to patients discharged in September 2006, an identical time in the academic cycle. The primary outcomes of interest were new template usage, mean lag time from discharge to DCS completion, and rate of DCS completion on day of discharge in all groups. Lag time with and without the new template in 2007 was a secondary outcome.

Results:

The new template was used for 80.5% of discharges from the teaching service and none of the discharges from the non‐teaching service in 2007; it was unavailable in 2006. On the teaching service, the lag time improved to 0.3 days in 2007 from 10.5 days in 2006, a 97% improvement (P < .001); 93.5% of summaries were completed on discharge day in 2007, compared with 32% in 2006 (P < .001). On the nonteaching service, the mean lag time and rate of DCS completion on day of discharge did not improve (5.5 days in 2007 versus 5.0 days in 2006, P = .76; 49% in 2007 versus 80.3% in 2006, P < .001). In 2007, the mean lag time on the teaching service was 0.04 days with the new template and 1.4 days without (P < .05); both were significantly better than the mean lag time on the teaching service in 2006 (P < .001).

Conclusions:

Our new template greatly improved DCS timeliness on the teaching service at our hospital, and residents voluntarily adopted it for most discharges. Use of a combined DCI/DCS template may represent an effective method to improve DCS timeliness and communication with PCPs. Further research is needed to determine its effect on PCP and patient satisfaction and on rehospital‐ization rates.

Author Disclosure:

R. Khanna, none; D. Wayne, none; J. Feinglass, none; M. Williams, none; Society of Hospital Medicine, editor, Journal of Hospital Medicine; L. Lindquist, none.