A hospital discharge summary quality improvement program featuring individual and team-based feedback and academic detailing.
BACKGROUND
Discharge summaries are an important component of hospital care transitions typically completed by interns in teaching hospitals. However, these documents are often not completed in a timely fashion or do not include pertinent details of hospitalization. This report outlines the development and impact of a curriculum intervention to improve the quality of discharge summaries by interns and residents in Internal Medicine. A previous study demonstrated that a discharge summary curriculum featuring individualized feedback was associated with improved summary quality, but few subsequent studies have described implementation of similar curricula. No information exists on the utility of other strategies such as team-based feedback or academic detailing.


METHODS
Study participants were 96 Internal Medicine intern and resident physicians at an academic medical center-based training program. A comprehensive evidence-based discharge summary quality improvement program was developed and implemented that featured a discharge summary template to facilitate summary preparation, individual feedback, team-based feedback, academic detailing and an objective discharge summary evaluation instrument.


RESULTS
The discharge summary evaluation instrument had moderate interrater reliability (κ = 0.72). Discharge summary scores improved from mean score of 70% to 82% (P = 0.05). Interns and residents participating in this program also reported increased confidence in producing and critiquing summaries.


CONCLUSIONS
A comprehensive discharge summary curriculum can be feasibly implemented within the context of a residency program. Team-based feedback and academic detailing may serve to reinforce individual feedback and extend program reach.
Center for Disease Prevention and Health Interventions for Diverse Populations (RNA), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina; Division of General Internal Medicine and Geriatrics (RNA, FTP, TRK, JM, YZ, PDM, WPM), Medical University of South Carolina, Charleston, South Carolina; Division of Biostatistics and Epidemiology (JZ), Medical University of South Carolina, Charleston, South Carolina; and South Carolina College of Pharmacy (PDM).
Robert N
RN
Axon
Fletcher T
FT
Penney
Thomas R
TR
Kyle
Jane
J
Zapka
Justin
J
Marsden
Yumin
Y
Zhao
Patrick D
PD
Mauldin
William P
WP
Moran
D000046:Academic Medical Centers / Q000379:methods / Q000592:standards*; D030141:Feedback, Psychological; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D010348:Patient Care Team / Q000592:standards*; D010351:Patient Discharge / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*