Audit and feedback: An intervention to improve discharge summary completion

Abstract

Discharge summaries (DS) communicate important clinical information from inpatient to outpatient settings. Previous studies noted increased adverse events and rehospitalization due to poor DS quality. We postulated that an audit and feedback intervention of DS completed by geriatric medicine fellows would improve the completeness of their summaries. We conducted a preintervention post intervention study. In phase 1 (AUDIT #1 and FEEDBACK) we scored all DS (n ¼ 89) completed by first year fellows between July 2006 to December 2006 using a 21-item checklist. Individual performance scores were reviewed with each fellow in 30-minute feedback sessions. In phase 2 (AUDIT #2) we scored all DS (n ¼ 79) completed after the first phase between February 2007 to July 2007 using the same checklist. Data were analyzed using generalized estimating equations. Fellows were more likely to complete all required DS data after feedback when compared with prior to feedback (91% vs. 71%, P < 0.001). Feedback was also associated with improved admission (93% vs. 70%, P < 0.001), duration of hospitalization (93% vs 78%, P < 0.001), discharge planning (93% vs. 18%, P < 0.02) and postdischarge care (83% vs. 57%., P < 0.001) section-specific information. In conclusion, audit and feedback sessions were associated with better DS completeness in areas of particular importance to geriatric care.

Optimizing the quality of hospital discharge summaries – a systematic review and practical tools

“…Additionally, common training instruments, such as audit and feedback, are helpful [32]. Structured feedback helped to reduce the length of the hospital stay, among other quality aspects [28]. This outcome is especially true when educational programs, feedback, template and incentives were combined [22,36].…”

“…Regarding question 1, 19 studies were included in this review [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. The analysis of these articles revealed considerable heterogeneity in the types of intervention and research design.…”

“…has shown [70]. To improve quality, the DS should be corrected and validated by a senior physician after a junior doctor has written it [28,29]. This procedure is required by the guidelines [19][20][21].…”

Auditing of Discharge Education to Coronary Angiography Patients

“…They found that nurses often had no responsibility regarding patient discharge coordination, and other unprofessional people were involved in this process (15). In addition, in another study, it was found that most discharge summary reports were not in accordance with the standards (16). Furthermore, findings reported by Makaryus and Friedman (2005) displayed that less than half of the patients that inquired during the discharge did not have adequate knowledge about the names of their drugs, purpose of their medications, and their common side effects (17).…”

An intervention to improve discharge summary completion rates within an Australian teaching hospital

“…[6] It has been suggested that direct individualised feedback can improve the quality and completion rates of discharge summaries. [10] Furthermore, to test whether adequately completed discharge summaries are associated with decreased hospital readmission rates, [6] the researcher tested the following research questions: Hypothesis 1: Individualized feedback improves the rates of discharge summary completion in targeted hospital areas.…”