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What’s in a Discharge Summary? :

October 23, 2020

Timely and high-quality communication following hospital discharge has been endorsed by leading pediatric groups.

Timely and high-quality communication following hospital discharge has been endorsed by leading pediatric groups.1-3 The written discharge summary provides critical information to ensure a safe transition from the hospital to the primary care provider (PCP). In this month’s Hospital Pediatrics(10.1542/hpeds.2020-0148), investigators reviewed 200 discharge summaries of hospitalized general pediatric patients in a single academic medical center for content and quality. Charts were reviewed for specific data elements, medical complexity, and the completion of specific discharge instructions. The investigators found that content and quality of discharge summary documentation was inconsistent. Notable findings included inaccuracies in discharge medications for patients with medical complexity. The lowest rates of completion and accuracy were discharge diagnosis, discharge medications, and follow up appointments.

I commend the authors for highlighting a widespread problem and opportunity. So why does this all matter? As hospitalists we want to ensure that the baton is safely handed off to the child’s PCP following discharge and that an unnecessary re-admission or adverse event does not occur. In the article, the authors point out the patient safety implications of incorrect discharge medications and follow up. As the authors suggest, one way to close the gaps is to harness the power of electronic medical records (EMR) to pull necessary data elements into templated notes more seamlessly. This is easier said than done in part, due to complexities within individual EMRs. Another opportunity within academic medical centers is with resident education since the bulk of each discharge summary is completed by residents.

A component of good communication with the PCP is a complete and accurate discharge summary but there is more to it. Sometimes, a beautifully written discharge summary may have nowhere to go because a PCP was not identified, the incorrect PCP is listed in the chart or the practice may not be set up to receive electronically routed discharge summaries. To mitigate this gap, our hospitalists call the PCP to give an additional verbal hand-off at discharge. There are obvious challenges to this task for a busy hospitalist on service and a busy primary care clinician both potentially pulled from patient care. For a medically complex patient, there is value to a conversation versus solely relying on a prescriptive, detailed and lengthy note which may have all the necessary elements but not always give the clearest picture of what’s next for the patient.

References

  1. Lye PS. Clinical report—physicians’ roles in coordinating care of hospitalized children. Pediatrics. 2010;126(4): 829-832.
  2. Leyenaar JK, Desai AD, Burkhart Q, et al. Quality measures to assess care transitions for hospitalized children. Pediatrics. 2016;138(2):e20160906
  3. Coghlin DT, Leyenaar JK, Shen M, et al. Pediatric discharge content: a multisite assessment of physician preferences and experiences. Hosp Pediatr. 2014;4(1):9-15.
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