title: Assessment of surgical discharge summaries and evaluation of a new quality improvement model.
abstract: BACKGROUND
  Discharge summaries after hospitalization provide the most reliable description and implications of the hospitalization. A concise discharge summary is crucial for maintaining continuity of care through the transition from inpatient to ambulatory care. Discharge summaries often lack information and are imprecise. Errors and insufficient recommendations regarding changes in the medical regimen may harm the patient's health and may result in readmission.
  
  
  OBJECTIVE
  To evaluate a quality improvement model and training program for writing postoperative discharge summaries for three surgical procedures.
  
  
  METHODS
  Medical records and surgical discharge summaries were reviewed and scored. Essential points for communication between surgeons and family physicians were included in automated forms. Staff was briefed twice regarding required summary contents with an interim evaluation. Changes in quality were evaluated.
  
  
  RESULTS
  Summaries from 61 cholecystectomies, 42 hernioplasties and 45 colectomies were reviewed. The average quality score of all discharge summaries increased from 72.1 to 78.3 after the first intervention (P < 0.0005) to 81.0 following the second intervention. As the discharge summary's quality improved, its length decreased significantly.
  
  
  CONCLUSIONS
  Discharge summaries lack important information and are too long. Developing a model for discharge summaries and instructing surgical staff regarding their contents resulted in measurable improvement. Frequent interventions and supervision are needed to maintain the quality of the surgical discharge summary.
authors.affiliation: Department of Surgery, Meir Medical Center, Kfar saba, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Stein
authors.forename: David
authors.initials: D
authors.lastname: Neufeld
authors.forename: Ivan
authors.initials: I
authors.lastname: Shwartz
authors.forename: Ilan
authors.initials: I
authors.lastname: Erez
authors.forename: Ilana
authors.initials: I
authors.lastname: Haas
authors.forename: Ada
authors.initials: A
authors.lastname: Magen
authors.forename: Elon
authors.initials: E
authors.lastname: Glassberg
authors.forename: Pavel
authors.initials: P
authors.lastname: Shmulevsky
authors.forename: Haim
authors.initials: H
authors.lastname: Paran
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards*; D004493:Education; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005194:Family Practice; D006784:Hospitals, Teaching / Q000379:methods; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D033183:Interdisciplinary Communication; D007557:Israel; D017146:Models, Organizational; D020380:Needs Assessment; D063886:Patient Discharge Summaries / Q000592:standards*; D058996:Quality Improvement; D013043:Specialties, Surgical