BACKGROUND: Discharge summaries are essential for safe transitions from hospital to home. OBJECTIVE: To conduct a comprehensive quality assessment of discharge summaries. DESIGN: Prospective cohort study. SUBJECTS: Three hundred seventy-seven patients discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia. MEASURES: Discharge summaries were assessed for timeliness of dictation, transmission of the summary to appropriate outpatient clinicians, and presence of key content including elements required by The Joint Commission and elements endorsed by 6 medical societies in the Transitions of Care Consensus Conference (TOCCC). RESULTS: A total of 376 of 377 patients had completed discharge summaries. A total of 174 (46.3%) summaries were dictated on the day of discharge; 93 (24.7%) were completed more than a week after discharge. A total of 144 (38.3%) discharge summaries were not sent to any outpatient physician. On average, summaries included 5.6 of 6 The Joint Commission elements and 4.0 of 7 TOCCC elements. Summaries dictated by hospitalists were more likely to be timely and to include key content than summaries dictated by housestaff or advanced practice nurses. Summaries dictated on the day of discharge were more likely to be sent to outside physicians and to include key content. No summary met all 3 quality criteria of timeliness, transmission, and content. CONCLUSIONS: Discharge summary quality is inadequate in many domains. This may explain why individual aspects of summary quality such as timeliness or content have not been associated with improved patient outcomes. However, improving discharge summary timeliness may also improve content and transmission.
BACKGROUND: Discharge summaries are essential for safe transitions from hospital to home. OBJECTIVE: To conduct a comprehensive quality assessment of discharge summaries. DESIGN: Prospective cohort study. SUBJECTS: Three hundred seventy-seven patients discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia. MEASURES: Discharge summaries were assessed for timeliness of dictation, transmission of the summary to appropriate outpatient clinicians, and presence of key content including elements required by The Joint Commission and elements endorsed by 6 medical societies in the Transitions of Care Consensus Conference (TOCCC). RESULTS: A total of 376 of 377 patients had completed discharge summaries. A total of 174 (46.3%) summaries were dictated on the day of discharge; 93 (24.7%) were completed more than a week after discharge. A total of 144 (38.3%) discharge summaries were not sent to any outpatient physician. On average, summaries included 5.6 of 6 The Joint Commission elements and 4.0 of 7 TOCCC elements. Summaries dictated by hospitalists were more likely to be timely and to include key content than summaries dictated by housestaff or advanced practice nurses. Summaries dictated on the day of discharge were more likely to be sent to outside physicians and to include key content. No summary met all 3 quality criteria of timeliness, transmission, and content. CONCLUSIONS: Discharge summary quality is inadequate in many domains. This may explain why individual aspects of summary quality such as timeliness or content have not been associated with improved patient outcomes. However, improving discharge summary timeliness may also improve content and transmission.
Authors: Luke O Hansen; Amy Strater; Lisa Smith; Jungwha Lee; Robert Press; Norman Ward; John A Weigelt; Peter Boling; Mark V Williams Journal: BMJ Qual Saf Date: 2011-04-22 Impact factor: 7.035
Authors: Melinda M Davis; Meg Devoe; Devan Kansagara; Christina Nicolaidis; Honora Englander Journal: J Gen Intern Med Date: 2012-07-25 Impact factor: 5.128
Authors: Amy J H Kind; Carolyn T Thorpe; Justin A Sattin; Stacy E Walz; Maureen A Smith Journal: J Gen Intern Med Date: 2011-09-07 Impact factor: 5.128
Authors: David M Maslove; Richard E Leiter; Joshua Griesman; Corinne Arnott; Ophyr Mourad; Chi-Ming Chow; Chaim M Bell Journal: J Gen Intern Med Date: 2009-07-16 Impact factor: 5.128
Authors: Vincenza Snow; Dennis Beck; Tina Budnitz; Doriane C Miller; Jane Potter; Robert L Wears; Kevin B Weiss; Mark V Williams Journal: J Gen Intern Med Date: 2009-04-03 Impact factor: 5.128
Authors: S Ryan Greysen; Danise Schiliro; Leslie Curry; Elizabeth H Bradley; Leora I Horwitz Journal: J Gen Intern Med Date: 2012-05-08 Impact factor: 5.128
Authors: Chaim M Bell; Jeffrey L Schnipper; Andrew D Auerbach; Peter J Kaboli; Tosha B Wetterneck; David V Gonzales; Vineet M Arora; James X Zhang; David O Meltzer Journal: J Gen Intern Med Date: 2008-12-20 Impact factor: 5.128
Authors: Jay G Berry; Kevin Blaine; Jayne Rogers; Sarah McBride; Edward Schor; Jackie Birmingham; Mark A Schuster; Chris Feudtner Journal: JAMA Pediatr Date: 2014-10 Impact factor: 16.193
Authors: Leora I Horwitz; John P Moriarty; Christine Chen; Robert L Fogerty; Ursula C Brewster; Sandhya Kanade; Boback Ziaeian; Grace Y Jenq; Harlan M Krumholz Journal: JAMA Intern Med Date: 2013-10-14 Impact factor: 21.873
Authors: Jason R Falvey; Robert E Burke; Daniel Malone; Kyle J Ridgeway; Beth M McManus; Jennifer E Stevens-Lapsley Journal: Phys Ther Date: 2016-03-03
Authors: Leora I Horwitz; Chohreh Partovian; Zhenqiu Lin; Jacqueline N Grady; Jeph Herrin; Mitchell Conover; Julia Montague; Chloe Dillaway; Kathleen Bartczak; Lisa G Suter; Joseph S Ross; Susannah M Bernheim; Harlan M Krumholz; Elizabeth E Drye Journal: Ann Intern Med Date: 2014-11-18 Impact factor: 25.391
Authors: Eric Young; Chad Stickrath; Monica McNulty; Aaron J Calderon; Elizabeth Chapman; Jed D Gonzalo; Ethan F Kuperman; Max Lopez; Christopher J Smith; Joseph R Sweigart; Cecelia N Theobald; Robert E Burke Journal: J Grad Med Educ Date: 2017-04