The effect of workload reduction on the quality of residents' discharge summaries.
BACKGROUND
The completeness of hospital discharge summaries may reflect the overall quality of inter-professional communications. The effect of reducing resident workload on clinical performance is largely unknown.


OBJECTIVE
We examined the impact of reducing housestaff workload on the quality of discharge summaries, an indicator of clinical performance, as compared to discharge summaries created by trainees on a team with a more typical workload.


METHODS
Patients admitted to a medicine service at a community teaching hospital affiliated with an academic medical center were alternately allocated between a control and intervention care team of residents. First-year residents on the intervention team carried an average census of 3.5 patients compared with 6.6 patients for peers on the control team. A random selection of 142 discharge summaries from a 3-month period were blindly evaluated using a structured tool based on professional documentation standards.


METHODS
61 internal medicine residents.


RESULTS
Inter-rater reliability of discharge summary quality was 0.9. Discharge summaries produced by residents on the intervention team with a reduced workload had significantly more of the required elements (74 vs 65%, p<0.001). Intervention team summaries were more frequently complete and contained significantly more of the required elements describing the patient history (65.7% vs 36.1%, p=0.0005), the inpatient narrative (47.1% vs 22.2%, p=0.003), discharge planning (20.0% vs 5.5%, p=0.012), and continuity of care (24.3% vs 6.9%, p=0.005). Fewer than a quarter of the summaries reviewed included discharge instructions, information on follow-up care, or a discharge medication list.


CONCLUSIONS
Reducing resident workload can significantly improve discharge summary quality, a measure of resident performance.
Coit
Margaret H
MH
Department of Medicine, Brigham and Women's Hospital, 221 Longwood Ave., RF-291, Boston, MA 02115, USA.
Katz
Joel T
JT
McMahon
Graham T
GT
D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D010351:Patient Discharge / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D014940:Work Schedule Tolerance; D016526:Workload / Q000592:standards*