Rethinking the discharge summary: a focus on handoff communication.

The discharge summary is one of the most critical documents in medical care settings, but it is prone to systematic lapses that compromise the continuity of care. Discontinuity is fostered not only by incomplete inclusion of data (such as pending labs or medication reconciliations) but also by failure to document clinical reasoning and unfinished diagnostic workups. To correct these problems, the authors propose the Situation-Background-Assessment-Recommendations (SBAR) format for discharge summaries. SBAR is already used for handoffs the way Subjective-Objective-Assessment-Plan is for progress notes. The SBAR format supports the concise presentation of relevant information along with guidance for action. It shifts the paradigm and purpose of the discharge summary away from being a "Captain's Log" (a historical record of the events, actions taken, and their consequences during hospitalization) and towards being a handoff document (a tool for communication between health professionals aimed at ensuring continuity of care). To test SBAR as a template for discharge summaries, the authors have initiated a study to document the impact of the SBAR model on the quality of trainees' thinking in discharge summaries.