title: Using a Structured Discharge Letter Template to Improve Communication During the Transition from a Specialized Outpatient Diabetes Clinic to a Primary Care Physician.
abstract: OBJECTIVE
  Transition from specialists to primary care physicians is dependent on clear communication by means of a discharge letter. Primary care physicians have indicated that letters from specialists rarely contain the details they require. As part of a quality-improvement project to improve the transition from diabetes clinics to primary care physicians, a structured discharge letter template was developed to facilitate the dictation of useful letters by specialists. The objective was to evaluate the content and quality of discharge letters created using a structured discharge letter template as compared to letters completed without the template.
  
  
  METHODS
  Retrospective study of patients treated at the Ottawa Hospital and discharged from the outpatient diabetes clinic between November 1, 2009, and December 1, 2010. The letters were reviewed by 2 independent reviewers and were assessed for content, brevity, clarity, management plan, organization and quality. Word count, dictation and transcription times were also compared.
  
  
  RESULTS
  Letters completed using the structured discharge letter template were more comprehensive and more likely to contain guidelines on management for glycemic control (51.1% vs. 14.1%; p<0.001); cardiovascular risk factors (65.61% vs. 9.8%; p<0.001); diabetes complications (79.9% vs. 5.9%; p<0.001); and provided re-referral criteria (89.3% vs. 15.7%; p<0.001). Dictation time did not differ between formats. Transcription time (20:65 min vs. 13:45 min; p<0.01) and word count (502 words vs. 292 words; p<0.001) were higher with the template.
  
  
  CONCLUSIONS
  The use of a structured discharge letter template improved the content and quality of discharge letters dictated by specialists. Primary care physicians were more consistently provided with valued information and given criteria for re-referral.
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Doyle
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address: jamalcolm@ottawahospital.on.ca.
authors.forename: Janine C
authors.initials: JC
authors.lastname: Malcolm
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Dora
authors.initials: D
authors.lastname: Liu
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Maranger
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Teik Chye
authors.initials: TC
authors.lastname: Ooi
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Keely
mesh_terms: D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000517:prevention & control / Q000523:psychology; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards*; D015709:Correspondence as Topic; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D010045:Outpatients / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data; D058007:Physicians, Primary Care; D036301:Qualitative Research; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013038:Specialization; D011795:Surveys and Questionnaires
keywords: Consultation letters; Diabetes; Diabète; Discharge letter; Letter templates; Lettre de congé; Lettres de consultation; Modèles de lettres; Transition des soins; Transition of care