title: Timeliness and quality of surgical discharge summaries after the implementation of an electronic format.
abstract: BACKGROUND
  As electronic discharge summaries (EDS) become more prevalent and health care systems increase their focus on transitions of care, analysis of EDS quality is important. The objective of this study was to assess the timeliness and quality of EDS compared with dictated summaries for surgical patients, which has not previously been evaluated.
  
  
  METHODS
  A retrospective study was conducted of a sample of discharge summaries from surgical patients at an urban university teaching hospital before and after the implementation of an EDS program. Summaries were evaluated on several dimensions, including time to summary completion, summary length, and summary quality, which was measured on a 13-item scoring tool.
  
  
  RESULTS
  After the exclusion of 5 patients who died, 195 discharge summaries were evaluated. Discharge summaries before and after EDS implementation were similar in admission types and discharge destinations of the patients. Compared with dictated summaries, EDS had equivalent overall quality (P = .11), with higher or equivalent scores on all specific quality aspects except readability. There was a highly significant statistical and clinical improvement in timeliness for electronic summaries (P < .01). Obvious use of copying and pasting was identified in 8% of discharge summaries and was associated with decreased readability (P = .02).
  
  
  CONCLUSIONS
  The implementation of EDS can improve the timeliness of summary completion without sacrificing quality for surgical patients. Excessive copying and pasting can reduce the readability of discharge summaries, and strategies to discourage this practice without the use of appropriate editing should be used.
authors.affiliation: Department of Surgery, Division of Surgery Education, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104, USA; Center for Healthcare Improvement and Patient Safety, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: caroline.reinke@uphs.upenn.edu.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Reinke
authors.affiliation: Department of Surgery, Division of Surgery Education, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104, USA.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Baillie
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Norris
authors.affiliation: Clinical Effectiveness and Quality Improvement, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Schmidt
authors.affiliation: Jefferson Medical College, Philadelphia, PA, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Wingate
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Healthcare Improvement and Patient Safety, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Myers
mesh_terms: D006785:Hospitals, University; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000592:standards*; D010351:Patient Discharge; D015143:Philadelphia; D017064:Process Assessment, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D013997:Time Factors; D014481:United States
keywords: Electronic discharge summary; Electronic medical record; Patient safety; Surgical education