title: Comprehensive quality of discharge summaries at an academic medical center.
abstract: BACKGROUND
  Discharge summaries are essential for safe transitions from hospital to home.
  
  
  OBJECTIVE
  To conduct a comprehensive quality assessment of discharge summaries.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Three hundred seventy-seven patients discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia.
  
  
  METHODS
  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.affiliation: Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA. leora.horwitz@yale.edu
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
authors.forename: Grace Y
authors.initials: GY
authors.lastname: Jenq
authors.forename: Ursula C
authors.initials: UC
authors.lastname: Brewster
authors.forename: Christine
authors.initials: C
authors.lastname: Chen
authors.forename: Sandhya
authors.initials: S
authors.lastname: Kanade
authors.forename: Peter H
authors.initials: PH
authors.lastname: Van Ness
authors.forename: Katy L B
authors.initials: KL
authors.lastname: Araujo
authors.forename: Boback
authors.initials: B
authors.lastname: Ziaeian
authors.forename: John P
authors.initials: JP
authors.lastname: Moriarty
authors.forename: Robert L
authors.initials: RL
authors.lastname: Fogerty
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000046:Academic Medical Centers / Q000379:methods / Q000592:standards*; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000592:standards*; D006801:Humans; D010351:Patient Discharge / Q000592:standards*; D063886:Patient Discharge Summaries / Q000592:standards*; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*