title: Opportunities to improve clinical summaries for patients at hospital discharge.
abstract: Clinical summaries are electronic health record (EHR)-generated documents given to hospitalised patients during the discharge process to review their hospital stays and inform postdischarge care. Presently, it is unclear whether clinical summaries include relevant content or whether healthcare organisations configure their EHRs to generate content in a way that promotes patient self-management after hospital discharge. We assessed clinical summaries in three relevant domains: (1) content; (2) organisation; and (3) readability, understandability and actionability.
  
  
  
  Two authors performed independent retrospective chart reviews of 100 clinical summaries generated at two Michigan hospitals using different EHR vendors for patients discharged 1 April -30 June 2014. We developed an audit tool based on the Meaningful Use view-download-transmit objective and the Society of Hospital Medicine Discharge Checklist (content); the Institute of Medicine recommendations for distributing easy-to-understand print material (organisation); and five readability formulas and the Patient Education Materials Assessment Tool (readability, understandability and actionability).
  
  
  
  Clinical summaries averaged six pages (range 3-12). Several content elements were universally auto-populated into clinical summaries (eg, medication lists); others were not (eg, care team). Eighty-five per cent of clinical summaries contained discharge instructions, more often generated from third-party sources than manually entered by clinicians. Clinical summaries contained an average of 14 unique messages, including non-clinical elements irrelevant to postdischarge care. Medication list organisation reflected reconciliation mandates, and dosing charts, when present, did not carry column headings over to subsequent pages. Summaries were written at the 8th-12th grade reading level and scored poorly on assessments of understandability and actionability. Inter-rater reliability was strong for most elements in our audit tool.
  
  
  
  Our study highlights opportunities to improve clinical summaries for guiding patients' postdischarge care.
authors.affiliation: Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.|Institute for Health Policy, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Sarzynski
authors.affiliation: Grand Rapids Medical Education Partners, Grand Rapids, Michigan, USA.
authors.forename: Hamza
authors.initials: H
authors.lastname: Hashmi
authors.affiliation: Grand Rapids Medical Education Partners, Grand Rapids, Michigan, USA.
authors.forename: Jeevarathna
authors.initials: J
authors.lastname: Subramanian
authors.affiliation: Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Fitzpatrick
authors.affiliation: Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.|Institute for Health Policy, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Polverento
authors.affiliation: Sparrow Health System, Lansing, Michigan, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Simmons
authors.affiliation: Institute for Health Policy, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Brooks
authors.affiliation: Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.|Institute for Health Policy, Michigan State University College of Human Medicine, East Lansing, Michigan, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Given
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032882:Comprehension; D057286:Electronic Health Records; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010351:Patient Discharge; D063886:Patient Discharge Summaries / Q000592:standards*; D010865:Pilot Projects; D012189:Retrospective Studies; D055815:Young Adult
keywords: Health services research; Medication safety; Patient education; Patient-centred care