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What Is Necessary for High-Quality Discharge Summaries?

Clinical Epidemiology Unit, Loeb Research Institute and Department of Medicine, University of Ottawa, Ottawa Hospital, Canada, carlv{at}lri.ca

Ella Rokosh, BSc, MD

University of Ottawa

The objective of this study was to determine what physicians perceive to be necessary for high-quality discharge summaries. One-on-one surveys of 100 hospital-based physicians-in-training and community family physicians were conducted. Participants indicated the amount that 56 items contributed to discharge summary quality on a 15-category ordinal scale. Results were transformed to a continuous scale, extending from -6.6 ("item makes summary useless") through 0 ("item has no effect on discharge summary quality") to 10 ("item is so essential that summary is useless without it"). Quality decreased significantly when summary length exceeded 2 pages and when the delay from patient discharge to summary delivery increased. Summary content that increased quality most included admission diagnosis (mean 8.2; 95% confidence interval [7.7, 8.61]), pertinent physical examination findings (6.6 [6.0, 7.2]) and laboratory results (6.8 [6.3, 7.4]), procedures (7.1 [6.7, 7.61]) and complications in hospital (7.1 [6.6, 7.51]), discharge diagnosis (8.8 [8.4,9.1]), discharge medications (7.9 [7.4, 8.41]), active medical problems at discharge (7.8 [7.4, 8.21]), and follow up (6.6 [6.0, 7.11]). With minor exceptions, hospital and family physicians agreed on contributors to summary quality. For this sample of physicians, summaries were of high quality when they were short, delivered quickly, and contained pertinent data that concentrated upon discharge information.

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