Creating a better discharge summary: improvement in quality and timeliness using an electronic discharge summary.

摘要

BACKGROUND: Deficits in information transfer between inpatient and outpatient physicians are common and potentially dangerous. OBJECTIVE: To evaluate the effect of a newly-created electronic discharge summary. DESIGN AND PARTICIPANTS: Pre-post evaluation of discharge summaries using a survey of outpatient physicians and a medical records review. MEASUREMENTS: Outpatient physicians' ratings of satisfaction with discharge summaries before and after implementation of an electronic discharge summary using a 5-point Likert scale (1 = very dissatisfied; 5 = very satisfied). Additionally, 196 randomly selected discharge summaries before and after implementation were rated for timeliness and presence of 16 key content areas by 3 internists. RESULTS: Two hundred and twenty-six of 416 (54%) and 256 of 397 (64%) outpatient physicians completed the baseline and postimplementation surveys. Satisfaction with quality and timeliness of discharge summaries improved with the use of the electronic discharge summary (mean quality rating 3.04 versus 3.64; P < 0.001, mean timeliness rating 2.59 versus 3.34; P < 0.001). A higher percentage of electronic discharge summaries were completed within 3 days of discharge as compared with dictated discharge summaries (44.8% versus 74.1%; P < 0.001). Several elements of the discharge summary were present more often with the electronic discharge summary, including discussion of follow-up issues (52.0% versus 75.8%; P = 0.001), pending test results (13.9% versus 46.3%; P < 0.001), and information provided to the patient and/or family (85.1% versus 95.8%; P = 0.01). CONCLUSIONS: The use of an electronic discharge summary significantly improved the quality and timeliness of discharge summaries.