Design and Hospitalwide Implementation of a Standardized Discharge Summary in an Electronic Health Record.
The hospital discharge summary is the primary method used to communicate a patient's plan of care to the next provider(s). Despite the existence of regulations and guidelines outlining the optimal content for the discharge summary and its importance in facilitating an effective transition to posthospital care, incomplete discharge summaries remain a common problem that may contribute to poor posthospital outcomes. Electronic health records (EHRs) are regularly used as a platform on which standardization of content and format can be implemented. The feasibility of designing and implementing a standardized discharge summary hospitalwide using an EHR was examined-to the authors' knowledge, for the first time.



This large-scale project at the University of Wisconsin Hospital and Clinics was led by a task force that had been assembled to develop best practices for EHR notes. The evidence-based Replicating Effective Programs (REP) model was employed to guide the development and implementation during the project. REP outlines four stages in clinical health service intervention implementation: preconditions, preimplementation, implementation, and maintenance.



At 18 months postimplementation, 90% of all hospital discharge summaries were written using the standardized format. Hospital providers found the template helpful and easy to use, and recipient providers perceived an improvement in the quality of discharge summaries compared to those previously sent from the hospital.



Discharge summaries can be standardized and implemented hospitalwide with both author and recipient provider satisfaction, particularly if evidence-based implementation strategies are employed. The use of EHR tools to guide clinicians in writing comprehensive discharge summaries holds promise in improving the existing deficits in communication at transitions of care.
Associate Professor of Pediatrics, Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health; Chief Medical Information Officer for UW Health, Madison. Electronic address: SDean@uwhealth.org.
Shannon M
SM
Dean
Formerly Advanced Fellow, William S. Middleton Memorial Veterans Affairs Hospital, Madison; Assistant Professor, University of Wisconsin-Madison School of Nursing.
Andrea
A
Gilmore-Bykovskyi
Professor of Medicine, Division of General Internal Medicine; Medical Director, Information Technology Services Strategic Projects, University of Wisconsin School of Medicine and Public Health.
Joel
J
Buchanan
UW Health.
Brad
B
Ehlenfeldt
Associate Professor of Medicine, Division of Geriatrics, University of Wisconsin School of Medicine and Public Health; Associate Director-Clinical, Geriatrics Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital.
Amy J H
AJ
Kind
D000046:Academic Medical Centers; D026683:Advisory Committees; D057286:Electronic Health Records; D055317:Evidence-Based Practice; D006302:Health Services Research; D006801:Humans; D063886:Patient Discharge Summaries / Q000592:standards*; D058996:Quality Improvement; D014922:Wisconsin