The Housestaff Incentive Program: improving the timeliness and quality of discharge summaries by engaging residents in quality improvement

Abstract

Our discharge summary improvement project provides an instructive example of how residents can lead clinically meaningful quality improvement projects.

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

“…However, simple clinical instructions to the addressees concerning the treatment plan are not necessarily effective, whereas detailed treatment plans, for example, for medications, are helpful [25,31,34]. The combination of structural and educational changes in a bundle has proven to have an impressive effect, according to a study by Bischoff et al [24].…”

“…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.…”

A Resident-led Initiative Improves Screening and Treatment for Vitamin D Deficiency in Patients with Hip Fractures

“…They used a biweekly audit and checklist program to encourage appropriate antibiotic use. A resident-led initiative resulted in increased adherence to improvements and timeliness in completing discharge summaries [3]. This program used frequent data reporting and discussion of best practices at monthly education meeting.…”

“…There is no clear optimal protocol for ensuring appropriate in-hospital and postdischarge treatment of low vitamin D levels [7]. Various other medical specialties, including internal medicine, radiology, and neurosurgery, have shown efficacy of resident-led quality improvement programs [3,8,19]. Additionally, the Accreditation Council for Graduate Medical Education (ACGME) has placed an emphasis on trainees learning systems-based practices [1].…”

Grading Residents’ Clinical Performance: Unique Opportunities and Challenges

“…On the other hand, programs such as those at the University of California, San Francisco have begun carefully using performance-based financial incentives for trainees, and early results are encouraging. 5 Notably, they have intentionally utilized program-level metrics, rather than individual ones, to determine compensation. As housestaff scorecards are generated, this tension must be directly studied and addressed.…”