Clinical summaries for hospitalised patients: time for higher standards

Kripalani, Sunil

doi:10.1136/bmjqs-2016-005826

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…Access to such written summaries of office visits is associated with improved adherence, patient and caregiver satisfaction, patient self-care, medical information recall, and preparedness for clinic visits [ 11 - 16 ]. However, there have been concerns about the accuracy and complexity of written summaries [ 12 - 14 ] and their low use by patients [ 15 ]. This issue is compounded by low levels of health literacy; 35% of Americans have below basic or basic health literacy [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Audio-/Videorecording Clinic Visits for Patient’s Personal Use in the United States: Cross-Sectional Survey

Barr¹,

Bonasia²,

Verma³

et al. 2018

J Med Internet Res

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BackgroundFew clinics in the United States routinely offer patients audio or video recordings of their clinic visits. While interest in this practice has increased, to date, there are no data on the prevalence of recording clinic visits in the United States.ObjectiveOur objectives were to (1) determine the prevalence of audiorecording clinic visits for patients’ personal use in the United States, (2) assess the attitudes of clinicians and public toward recording, and (3) identify whether policies exist to guide recording practices in 49 of the largest health systems in the United States.MethodsWe administered 2 parallel cross-sectional surveys in July 2017 to the internet panels of US-based clinicians (SERMO Panel) and the US public (Qualtrics Panel). To ensure a diverse range of perspectives, we set quotas to capture clinicians from 8 specialties. Quotas were also applied to the public survey based on US census data (gender, race, ethnicity, and language other than English spoken at home) to approximate the US adult population. We contacted 49 of the largest health systems (by clinician number) in the United States by email and telephone to determine the existence, or absence, of policies to guide audiorecordings of clinic visits for patients’ personal use. Multiple logistic regression models were used to determine factors associated with recording.ResultsIn total, 456 clinicians and 524 public respondents completed the surveys. More than one-quarter of clinicians (129/456, 28.3%) reported that they had recorded a clinic visit for patients’ personal use, while 18.7% (98/524) of the public reported doing so, including 2.7% (14/524) who recorded visits without the clinician’s permission. Amongst clinicians who had not recorded a clinic visit, 49.5% (162/327) would be willing to do so in the future, while 66.0% (346/524) of the public would be willing to record in the future. Clinician specialty was associated with prior recording: specifically oncology (odds ratio [OR] 5.1, 95% CI 1.9-14.9; P=.002) and physical rehabilitation (OR 3.9, 95% CI 1.4-11.6; P=.01). Public respondents who were male (OR 2.11, 95% CI 1.26-3.61; P=.005), younger (OR 0.73 for a 10-year increase in age, 95% CI 0.60-0.89; P=.002), or spoke a language other than English at home (OR 1.99; 95% CI 1.09-3.59; P=.02) were more likely to have recorded a clinic visit. None of the large health systems we contacted reported a dedicated policy; however, 2 of the 49 health systems did report an existing policy that would cover the recording of clinic visits for patient use. The perceived benefits of recording included improved patient understanding and recall. Privacy and medicolegal concerns were raised.ConclusionsPolicy guidance from health systems and further examination of the impact of recordings—positive or negative—on care delivery, clinician-related outcomes, and patients’ behavioral and health-related outcomes is urgently required.

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Section: Introductionmentioning

confidence: 99%

Audio-/Videorecording Clinic Visits for Patient’s Personal Use in the United States: Cross-Sectional Survey

Barr¹,

Bonasia²,

Verma³

et al. 2018

J Med Internet Res

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“…We need more expansive care delivery changes. 72 Novel care models could integrate inpatient and outpatient management for high risk patients, reducing care discontinuity. 73 Patients might be best supported by community "health agents" to facilitate the move from one care setting to the next.…”

Section: Patient Engagement In Transitions Of Carementioning

confidence: 99%

Rethinking medical ward quality

Pannick

Wachter

Vincent

et al. 2016

BMJ

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Rethinking medical ward qualityFor quality to improve, we need to embrace the complexities of general medical inpatient care, say Samuel Pannick and colleagues Medical wards deliver the majority of acute inpatient care in health systems worldwide. This care is expensive, costing the NHS around £5bn (€5.5bn; $6.2bn) a year, a quarter of its inpatient expenditure.1 Improving the performance of medical wards is an international priority, 2 3 not only because of the scale of care that they deliver. Their core workload-treating complex, increasingly frail patients in a time pressurised setting-represents the broader challenges facing healthcare. 4 Yet major gaps remain in our understanding of how wards perform. [5][6][7] Safety and quality interventions have been most effective in improving standardised clinical tasks in the operating theatre and intensive care unit, such as the insertion of central venous catheters. The processes of ward care require a more nuanced approach to improvement. Medical patients' clinical syndromes often fall between traditional diagnostic categories, 8 and specific organisational challenges exist for the teams that care for them. We discuss the unique properties of medical wards and the problems they face, before setting out a vision for ward improvement that embraces the complexity of ward care. The medical ward is a different animalImportant differences exist between medical wards and other clinical settings, from haemodialysis units to operating theatres. Medical ward teams care for a particularly heterogeneous group of patients, with no single best pathway for diagnosis or treatment. Staff are skilled in the management of a diverse range of conditions, from pyelonephritis to gastrointestinal bleeding and terminal cancer. Many patients arrive without a diagnosis; indeed, empirical treatment can be concluded with no definitive diagnosis ever established. This sets medical wards apart from other hospital settings, which typically manage more narrowly defined patient populations with more predictable care trajectories. With such heterogeneity, medical ward teams may struggle to articulate their clinical and business aims and are better defined by their interpersonal networks and the flow of information within them. 9Episodes of medical ward care can be long, involving large, dynamic, multidisciplinary teams. Team members are often dispersed throughout the hospital; physicians and allied health professionals are rarely located together on one unit with nurses and their patients. Frequent handovers are made more difficult by the absence of a central procedure around which a structured care narrative can be formed.Errors are common and often serious-medical ward patients have the same risks of preventable and fatal adverse events as those in intensive care, 7 10 and preventable hospital deaths are disproportionately caused by failures in general ward care. 6 Crucially, ward failures are different from the procedural misadventures of the operating theatre or intensive care unit, 10 re...

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“…The goal of these documents is to summarize patients’ health information and guide self-management tasks, yet opportunities exist to optimize clinical summaries for patients and their caregivers. 1,2 Our team is conducting a secondary analysis of the Michigan Stroke Transitions Trial 3 to quantify discrepancies between 2 EHR-generated documents produced at hospital discharge: (1) clinical summaries (intended for patients) and (2) discharge summaries (intended for providers). While reviewing clinical summaries from 3 unaffiliated health systems, we discovered an important issue: accessing these documents via different EHR workflows results in different versions—one static and one dynamic.…”

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confidence: 99%