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Zahl-Holmstad B, Garcia BH, Svendsen K, Johnsgård T, Holis RV, Ofstad EH, Risør T, Lehnbom EC, Wisløff T, Chan M, Elenjord R. Completeness of medication information in admission notes from emergency departments. BMC Health Serv Res 2023; 23:1425. [PMID: 38104071 PMCID: PMC10724918 DOI: 10.1186/s12913-023-10371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Medication lists prepared in the emergency department (ED) form the basis for diagnosing and treating patients during hospitalization. Since incomplete medication information may lead to patient harm, it is crucial to obtain a correct and complete medication list at hospital admission. In this cross-sectional retrospective study we wanted to explore medication information completeness in admission notes from Norwegian EDs and investigate which factors were associated with level of completeness. METHODS Medication information was assessed for completeness by applying five evaluation criteria; generic name, formulation, dose, frequency, and indication for use. A medication completeness score in percent was calculated per medication, per admission note and per criterion. Quantile regression analysis was applied to investigate which variables were associated with medication information completeness. RESULTS Admission notes for patients admitted between October 2018 and September 2019 and using at least one medication were included. A total of 1,080 admission notes, containing 8,604 medication orders, were assessed. The individual medications had a mean medication completeness score of 88.1% (SD 16.4), while admission notes had a mean medication completeness score of 86.3% (SD 16.2). Over 90% of all individual medications had information about generic name, formulation, dose and frequency stated, while indication for use was only present in 60%. The use of an electronic tool to prepare medication information had a significantly strong positive association with completeness. Hospital visit within the last 30 days, the patient's living situation, number of medications in use, and which hospital the patient was admitted to, were also associated with information completeness. CONCLUSIONS Medication information completeness in admission notes was high, but potential for improvement regarding documentation of indication for use was identified. Applying an electronic tool when preparing admission notes in EDs seems crucial to safeguard completeness of medication information.
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Affiliation(s)
- Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway.
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway.
| | - Beate H Garcia
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Kristian Svendsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renata V Holis
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
| | - Eirik H Ofstad
- Department of Medicine, Nordland Hospital Trust, Parkveien 95, Bodø, 8005, Norway
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Torsten Risør
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1014, Denmark
| | - Elin C Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar, 392 31, Sweden
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, Nordbyhagen, Lørenskog, 1478, Norway
| | - Macty Chan
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
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Lewis AE, Weiskopf N, Abrams ZB, Foraker R, Lai AM, Payne PRO, Gupta A. Electronic health record data quality assessment and tools: a systematic review. J Am Med Inform Assoc 2023; 30:1730-1740. [PMID: 37390812 PMCID: PMC10531113 DOI: 10.1093/jamia/ocad120] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/16/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE We extended a 2013 literature review on electronic health record (EHR) data quality assessment approaches and tools to determine recent improvements or changes in EHR data quality assessment methodologies. MATERIALS AND METHODS We completed a systematic review of PubMed articles from 2013 to April 2023 that discussed the quality assessment of EHR data. We screened and reviewed papers for the dimensions and methods defined in the original 2013 manuscript. We categorized papers as data quality outcomes of interest, tools, or opinion pieces. We abstracted and defined additional themes and methods though an iterative review process. RESULTS We included 103 papers in the review, of which 73 were data quality outcomes of interest papers, 22 were tools, and 8 were opinion pieces. The most common dimension of data quality assessed was completeness, followed by correctness, concordance, plausibility, and currency. We abstracted conformance and bias as 2 additional dimensions of data quality and structural agreement as an additional methodology. DISCUSSION There has been an increase in EHR data quality assessment publications since the original 2013 review. Consistent dimensions of EHR data quality continue to be assessed across applications. Despite consistent patterns of assessment, there still does not exist a standard approach for assessing EHR data quality. CONCLUSION Guidelines are needed for EHR data quality assessment to improve the efficiency, transparency, comparability, and interoperability of data quality assessment. These guidelines must be both scalable and flexible. Automation could be helpful in generalizing this process.
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Affiliation(s)
- Abigail E Lewis
- Division of Computational and Data Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Nicole Weiskopf
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Zachary B Abrams
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Randi Foraker
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Albert M Lai
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Philip R O Payne
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Aditi Gupta
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
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Sizemore J, Bailey A, Sankineni S, Clark K, Manivannan S, Kolar M, Warden M, Sofka S. Training to Transition: Using Simulation-Based Training to Improve Resident Physician Confidence in Hospital Discharges. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11348. [PMID: 37720418 PMCID: PMC10502193 DOI: 10.15766/mep_2374-8265.11348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/13/2023] [Indexed: 09/19/2023]
Abstract
Introduction Hospital discharge is a highly critical and complex process that is prone to medical errors, poor communication, and ineffective synchronization of transitional teams. Improving safety during postacute care transitions has become a national focus. Simulation-based training is an underutilized method of instruction for medical resident transitions of care education. Methods As an integral part of a transitions curriculum, 36 PGY 1 residents from internal medicine and transitional year residency programs underwent a discharge simulation utilizing a trained simulated participant (SP) and a lay caregiver. The objective of the training was to implement a simulation-based education intervention to improve transition practices and discharge communication in graduate medical education. A faculty observer used a case-specific discharge rubric to standardize feedback to the resident and observed the resident navigate the electronic medical record (EMR) for discharge orders. Pretest and posttest surveys assessing resident attitudes and confidence regarding specific areas of the discharge process were distributed to all participating residents for completion. Results Thirty-six internal medicine and transitional year residents (100%) completed an observed discharge simulation with an SP and a separate encounter with the EMR discharge navigator. All 36 residents (100%) completed the pretest survey, and 23 (63%) completed the postsurvey evaluation. Postsurvey results showed residents agreed (92%, p < .05) that the simulation increased their confidence in safely discharging a patient. Discussion Simulation encounters are an effective adjunct to postacute care transition education.
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Affiliation(s)
- Jenna Sizemore
- Assistant Professor and Associate Program Director, Internal Medicine Residency Program, Department of Medicine, West Virginia University School of Medicine
| | - Andrea Bailey
- Clinical Assistant Professor and Director of Simulation, West Virginia University School of Nursing
| | - Spoorthi Sankineni
- Consulting Associate, Duke Primary Care and Department of Medicine, Duke University School of Medicine
| | - Karen Clark
- Professor, Department of Medicine, West Virginia University School of Medicine
| | - Shanthi Manivannan
- Associate Professor and Section Chief, Department of Medicine, West Virginia University School of Medicine
| | - Maria Kolar
- Professor, Department of Medicine, and Associate Program Director, Transitional Year Residency Program, West Virginia University School of Medicine
| | - Mary Warden
- Associate Professor, Department of Medicine and Department of Medical Education, and Program Director, Transitional Year Residency Program, West Virginia University School of Medicine
| | - Sarah Sofka
- Professor, Department of Medicine, and Program Director, Internal Medicine Residency Program, West Virginia University School of Medicine
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Henriksen BT, Krogseth M, Andersen RD, Davies MN, Nguyen CT, Mathiesen L, Andersson Y. Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial. J Orthop Surg Res 2023; 18:434. [PMID: 37312222 DOI: 10.1186/s13018-023-03906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Hip fracture patients face a patient safety threat due to medication discrepancies and adverse drug reactions when they have a combination of high age, polypharmacy and several care transitions. Consequently, optimised pharmacotherapy through medication reviews and seamless communication of medication information between care settings is necessary. The primary aim of this study was to investigate the impact on medication management and pharmacotherapy. The secondary aim was to evaluate implementation of the novel Patient Pathway Pharmacist intervention for hip fracture patients. METHODS Hip fracture patients were included in this nonrandomised controlled trial, comparing a prospective intervention group (n = 58) with pre-intervention controls who received standard care (n = 50). The Patient Pathway Pharmacist intervention consisted of the steps: (A) medication reconciliation at admission to hospital, (B) medication review during hospitalisation, (C) recommendation for the medication information in the hospital discharge summary, (D) medication reconciliation at admission to rehabilitation, and (E) medication reconciliation and (F) review after hospital discharge. The primary outcome measure was quality score of the medication information in the discharge summary (range 0-14). Secondary outcomes were potentially inappropriate medications (PIMs) at discharge, proportion receiving pharmacotherapy according to guidelines (e.g. prophylactic laxatives and osteoporosis pharmacotherapy), and all-cause readmission and mortality. RESULTS The quality score of the discharge summaries was significantly higher for the intervention patients (12.3 vs. 7.2, p < 0.001). The intervention group had significantly less PIMs at discharge (- 0.44 (95% confidence interval - 0.72, - 0.15), p = 0.003), and a higher proportion received prophylactic laxative (72 vs. 35%, p < 0.001) and osteoporosis pharmacotherapy (96 vs. 16%, p < 0.001). There were no differences in readmission or mortality 30 and 90 days post-discharge. The intervention steps were delivered to all patients (step A, B, E, F = 100% of patients), except step (C) medication information at discharge (86% of patients) and step (D) medication reconciliation at admission to rehabilitation (98% of patients). CONCLUSION The intervention steps were successfully implemented for hip fracture patients and contributed to patient safety through a higher quality medication information in the discharge summary, fewer PIMs and optimised pharmacotherapy. TRIAL REGISTRATION NCT03695081.
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Affiliation(s)
- Ben Tore Henriksen
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway.
- Division of Surgery, Vestfold Hospital Trust, Tonsberg, Norway.
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
| | - Maria Krogseth
- Old Age Psychiatry Research Network, Telemark Vestfold, Vestfold Hospital Trust, Tonsberg, Norway
| | - Randi Dovland Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maren Nordsveen Davies
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
| | - Caroline Thy Nguyen
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Tromso, Tromso, Norway
| | - Liv Mathiesen
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Yvonne Andersson
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
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Henriksen BT, Krogseth M, Nguyen CT, Mathiesen L, Davies MN, Andersen RD, Andersson Y. Medication management for patients with hip fracture at a regional hospital and associated primary care units in Norway: a descriptive study based on a survey of clinicians' experience and a review of patient records. BMJ Open 2022; 12:e064868. [PMID: 36379642 PMCID: PMC9668037 DOI: 10.1136/bmjopen-2022-064868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Patients with hip fracture are at high risk of medication errors due to a combination of high age, comorbidities, polypharmacy and several care transitions after fracture. The aim was to study medication management tasks concerning patient safety: medication reconciliation, medication review and communication of key medication information in care transitions. DESIGN Descriptive study comprising a self-administered clinician survey (MedHipPro-Q) and a retrospective review of hospital medical records of patients with hip fracture. SETTING Regional hospital and the associated primary care units (South-Eastern Norway). PARTICIPANTS The survey received responses from 253 clinicians, 61 medical doctors and 192 nurses, involved in the medication management of patients with hip fracture, from acute admittance to the regional hospital, through an in-hospital fast track, primary care rehabilitation and back to permanent residence. Respondents' representativeness was unknown, introducing a risk of selection and non-response bias, and extrapolating findings should be done with caution. The patient records review included a random sample of records of patients with hip fracture (n=50). OUTCOME MEASURES Medication reconciliation, medication review and communication of medication information from two perspectives: the clinicians' (ie, experiences with medication management) and the practice (ie, documentation of completed medication management). RESULTS In the survey, most clinicians stated they performed medication reconciliation (79%) and experienced that patients often arrived without a medication list after care transition (37%). Doctors agreed that more patients would benefit from medication reviews (86%). In the hospital patient records, completed medication reconciliation was documented in most patients (76%). Medication review was documented in 2 of 50 patients (4%). Discharge summary guidelines were followed fully for 3 of 50 patients (6%). CONCLUSION Our study revealed a need for improved medication management for patients with hip fracture. Patients were at risk of medication information not being transferred correctly between care settings, and medication reviews seemed to be underused in clinical practice.
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Affiliation(s)
- Ben Tore Henriksen
- Tonsberg Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
- Division of Surgery, Vestfold Hospital Trust, Tonsberg, Norway
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Maria Krogseth
- Old Age Psychiatry Research Network, Telemark Vestfold, Vestfold Hospital Trust, Tonsberg, Norway
- Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
- Department of Internal Medicine, Telemark Hospital Trust, Skien, Norway
| | - Caroline Thy Nguyen
- Tonsberg Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Liv Mathiesen
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Maren Nordsveen Davies
- Tonsberg Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
| | - Randi Dovland Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norway
- Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yvonne Andersson
- Department of Research, Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
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Scarfield P, Shepherd TD, Stapleton C, Starks A, Benn E, Khalid S, Dayment B, Moate A, Mohamed S, Lee J. Improving the quality and content of discharge summaries on acute medicine wards: a quality improvement project. BMJ Open Qual 2022; 11:bmjoq-2021-001780. [PMID: 35393294 PMCID: PMC8991046 DOI: 10.1136/bmjoq-2021-001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/27/2022] [Indexed: 11/18/2022] Open
Abstract
Discharge summaries are important medical documents that summarise a patient’s hospital admission. The Royal College of Physicians provides standardised guidance on the content of discharge summaries, given their important role as a handover document to general practitioners (GPs). Our project started in June 2020 on an acute medical ward, where significant variation had been noted in the quality and content of discharge summaries. A multidisciplinary team (MDT) was formed including doctors, nurses and hospital/community pharmacists, as well as a patient representative, to ensure active patient co-design. The problem was scoped by asking GPs to provide feedback via surveys and process mapping. Our aim was to increase the compliance of discharge summaries with 10 core criteria from a baseline of 55% to 95% by June 2021. Change ideas were developed by the MDT and were tested using plan–do–study–act (PDSA) cycles that included additional pharmacy support, a discharge summary template and individualised feedback. The project reached its goal of 95% compliance in January 2021, 5 months ahead of the target date, and this improvement has been sustained since. The project expanded to a second acute medical unit ward in May 2021. The expanded project reached its goal of 90% compliance within 6 weeks and maintained sustained improvement with further PDSA cycles. A standard operating procedure has been created to help embed the changes on these wards. Our future aims are to redesign and improve the current electronic system and to help spread positive changes throughout the Trust.
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Affiliation(s)
| | | | | | - Alexandra Starks
- Quality Improvement, Lewisham and Greenwich NHS Trust, London, UK
| | - Ellen Benn
- Acute Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Sara Khalid
- Acute Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Bryony Dayment
- Acute Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Alex Moate
- Acute Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Sandra Mohamed
- Acute Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Jasmine Lee
- Acute Medicine, Lewisham and Greenwich NHS Trust, London, UK
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Silver AM, Goodman LA, Chadha R, Higdon J, Burton M, Palabindala V, Jonnalagadda N, Thomas A, O'Donnell C. Optimizing Discharge Summaries: A Multispecialty, Multicenter Survey of Primary Care Clinicians. J Patient Saf 2022; 18:58-63. [PMID: 33395016 DOI: 10.1097/pts.0000000000000809] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient care in the United States has become increasingly more fragmented, and the discharge summary serves as a critical tool for transmitting information on a patient's hospital admission to the primary care clinician. Some guidelines regarding how to write discharge summaries exist, but few are focused on prioritizing content that is most important to optimize a patient's transition of care. METHODS We conducted a national survey across various medical primary care specialties, including trainees and advanced practice providers, to understand the priorities of primary care clinicians. We distributed the survey to 2184 clinicians affiliated with 8 large academic institutions. Our response rate was 21%. RESULTS Hospital course, discharge diagnoses, medication reconciliation, and follow-up sections were ranked as the most important categories with a 95.5% concordance rate among surveyed institutions. The least important sections were contact numbers for inpatient clinicians, ancillary services, weight-bearing status, and wound care. Similar themes were also identified via consensus review of the free-texted comments, adding that discharge summary style was also important. Other identified barriers to high-quality transition of care are both the limited time primary care clinicians can spend reviewing discharge summaries and lack of adequate communication between hospitalists and the outpatient clinician. CONCLUSIONS High-yield content should be presented at the beginning of the discharge summary and conveyed in a brief, succinct manner to ensure maximal utility of the document as a transition of care tool.
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Affiliation(s)
- Aaron M Silver
- From the Department of Pediatrics, Department of Medicine, University of Arizona Internal Medicine and Pediatrics Residency Program
| | - Leigh Anne Goodman
- Department of Medicine, Banner-University Medical Center Phoenix, Phoenix, Arizona
| | - Romil Chadha
- Department of Medicine, University of Kentucky, Lexington, Kentucky
| | - Jason Higdon
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Michael Burton
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Abey Thomas
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Visade F, Lefebvre A, Floret E, Decaudin B, Puisieux F, Delecluse C, Beuscart JB. Proposition of a structured list of information items to be transmitted to primary caregivers after in-hospital medication optimization: a qualitative study. Acta Clin Belg 2021; 76:184-189. [PMID: 31787034 DOI: 10.1080/17843286.2019.1699689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and objective: Defective transmission of drug information during the transition from hospital to home care are causes of adverse drug reactions in older patients. We aimed to reach a consensus concerning information about changes in treatment to be transmitted to primary caregivers when an older patient is discharged from hospital.Methods: A qualitative focus group study was conducted with general practitioners, geriatricians, community pharmacists, and hospital pharmacists providing care for older patients. Four steps were used to reach a focus group consensus: 1) presentation of the purpose of the focus group; 2) generation and enumeration of ideas; 3) sharing opinions about these ideas; 4) voting to create a list of ranked items. The process involved three focus groups.Results: A consensus was reached on ten items: indication for continued, discontinued, newly introduced or changed treatments and their duration; reasons for discontinuing drugs or introducing new drugs; information about re-evaluating treatments; reasons for hospital stay, significant elements and diagnosis at discharge; administrative information concerning the patient; the name of the primary care physician, and the discharging hospital unit and the physician(s) in charge; known allergies, information about liver and kidney failure; main adverse effects to monitor; date of latest blood tests; hospital admission/discharge dates.Conclusion: The consensus on the list of information items concerning changes in the treatment should be used by hospital physicians and pharmacists to ensure safe patient discharge.
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Affiliation(s)
- Fabien Visade
- Geriatrics Department, Lille Catholic Hospitals, University of Lille, Lomme, France
- Univ. Lille, EA2694 - Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Antoine Lefebvre
- Department of Pharmacy, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Emmanuel Floret
- Department of Pharmacy, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Bertrand Decaudin
- Univ. Lille, EA 7365-GRITA-Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
- CHU Lille, Department of pharmacology, F-59000 Lille, France
| | - François Puisieux
- CHU Lille, Department of pharmacology, F-59000 Lille, France
- CHU Lille, Department of Geriatrics, F-59000 Lille, France
| | - Céline Delecluse
- Geriatrics Department, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, EA2694 - Evaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
- CHU Lille, Department of Geriatrics, F-59000 Lille, France
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Troude P, Nieto I, Brion A, Goudinoux R, Laganier J, Ducasse V, Nizard R, Martinez F, Segouin C. Assessing the impact of a quality improvement program on the quality and timeliness of discharge documents: A before and after study. Medicine (Baltimore) 2020; 99:e23776. [PMID: 33371146 PMCID: PMC7748348 DOI: 10.1097/md.0000000000023776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
Whereas handover of pertinent information between hospital and primary care is necessary to ensure continuity of care and patient safety, both quality of content and timeliness of discharge summary need to be improved. This study aims to assess the impact of a quality improvement program on the quality and timeliness of the discharge summary/letter (DS/DL) in a University hospital with approximatively 40 clinical units using an Electronic medical record (EMR).A discharge documents (DD) quality improvement program including revision of the EMR, educational program, audit (using scoring of DD) and feedback with a ranking of clinical units, was conducted in our hospital between October 2016 and November 2018. Main outcome measures were the proportion of the DD given to the patient at discharge and the mean of the national score assessing the quality of the discharge documents (QDD score) with 95% confidence interval.Intermediate evaluation (2017) showed a significant improvement as the proportion of DD given to patients increased from 63% to 85% (P < .001) and mean QDD score rose from 41 (95%CI [36-46]) to 74/100 (95%CI [71-77]). In the final evaluation (2018), the proportion of DD given to the patient has reached 95% and the mean QDD score was 82/100 (95% CI [80-85]). The areas of the data for admission and discharge treatments remained the lowest level of compliance (44%).The involvement of doctors in the program and the challenge of participating units have fostered the improvement in the quality of the DD. However, the level of appropriation varied widely among clinical units and completeness of important information, such as discharge medications, remains in need of improvement.
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Affiliation(s)
| | | | - Annie Brion
- Direction des Usagers, du Système d’Information et de la Qualité
| | | | | | | | - Rémy Nizard
- Service de chirurgie orthopédique, HU Saint-Louis – Lariboisière – Fernand Widal, AP-HP, Paris, France
| | - Fabien Martinez
- Direction des Usagers, du Système d’Information et de la Qualité
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Earnshaw CH, Pedersen A, Evans J, Cross T, Gaillemin O, Vilches-Moraga A. Improving the quality of discharge summaries through a direct feedback system. Future Healthc J 2020; 7:149-154. [PMID: 32550646 PMCID: PMC7296566 DOI: 10.7861/fhj.2019-0046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION There is a recognised need to improve the quality of discharge documentation to facilitate the safe and effective ongoing care of patients once they leave hospital. Previous studies have focused on individual interventions, such as teaching or feedback. Our continuous quality improvement project aims to improve the quality of discharge documentation at our hospital by providing a comprehensive overhaul of the education and feedback around discharge documentation. METHODS We designed a comprehensive data analysis tool to analyse the performance of our discharge summaries. We presented at clinical governance sessions and arranged numerous teaching sessions for junior doctors. We developed a live-feedback system based on the content of a sample set of the previous month's summaries, which included poster-based feedback and group teaching. RESULTS Our interventions have significantly improved the quality of our discharge documentation across a broad range of categories, including the summary of the stay, actions for general practitioners and information given to patients in lay terminology. CONCLUSION Our comprehensive quality improvement project has improved the quality of our discharge documentation. Further work aims to expand this project into a regional setting, as well as designing a strategy to maintain engagement of key stakeholders to ensure continued progress.
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Affiliation(s)
| | | | - Jo Evans
- BSalford Royal NHS Foundation Trust, Salford, UK
| | - Tina Cross
- ASalford Royal NHS Foundation Trust, Salford, UK
| | | | - Arturo Vilches-Moraga
- CSalford Royal NHS Foundation Trust, Salford, UK,Address for correspondence: Dr Arturo Vilches-Moraga, Department of Ageing and Complex Medicine, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
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Elliott RA, Tan Y, Chan V, Richardson B, Tanner F, Dorevitch MI. Pharmacist-Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability. PHARMACY 2019; 8:pharmacy8010002. [PMID: 31905902 PMCID: PMC7151653 DOI: 10.3390/pharmacy8010002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/16/2019] [Accepted: 12/27/2019] [Indexed: 11/16/2022] Open
Abstract
Inaccurate or missing medication information in medical discharge summaries is a widespread and intractable problem. This study evaluated the effectiveness and sustainability of an intervention in which ward-based hospital pharmacists reviewed, contributed and verified medication information in electronic discharge summaries (EDSs) in collaboration with physicians. Retrospective audits of randomly selected EDSs were conducted on seven wards at a major public hospital before and after implementation of the intervention and repeated two years later on four wards where the intervention was incorporated into usual pharmacist care. EDSs for 265 patients (prescribed a median of nine discharge medications) were assessed across the three time points. Pharmacists verified the EDSs for 47% patients in the first post-intervention audit and 68% patients in the second post-intervention audit. Following the intervention, the proportion of patients with one or more clinically significant discharge medication list discrepancy fell from 40/93 (43%) to 14/92 (15%), p < 0.001. The proportion of clinically significant medication changes stated in the EDSs increased from 222/417 (53%) to 296/366 (81%), p < 0.001, and the proportion both stated and explained increased from 206/417 (49%) to 245/366 (67%), p < 0.001. Significant improvements were still evident after two years. Pharmacists spent a median of 5 (range 2-16) minutes per patient contributing to EDSs. Logistics, timing and pharmacist workload were barriers to delivering the intervention. Additional staff resources is needed to enable pharmacists to consistently deliver this effective intervention.
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Affiliation(s)
- Rohan A. Elliott
- Pharmacy Department, Austin Health, Heidelberg, VIC 3084, Australia; (Y.T.); (V.C.); (B.R.); (F.T.)
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC 3052, Australia
- Correspondence: ; Tel.: +61-9496-2334
| | - Yixin Tan
- Pharmacy Department, Austin Health, Heidelberg, VIC 3084, Australia; (Y.T.); (V.C.); (B.R.); (F.T.)
- Pharmacy Department, Waitemata District Health Board, Auckland 0620, New Zealand
| | - Vincent Chan
- Pharmacy Department, Austin Health, Heidelberg, VIC 3084, Australia; (Y.T.); (V.C.); (B.R.); (F.T.)
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Belinda Richardson
- Pharmacy Department, Austin Health, Heidelberg, VIC 3084, Australia; (Y.T.); (V.C.); (B.R.); (F.T.)
| | - Francine Tanner
- Pharmacy Department, Austin Health, Heidelberg, VIC 3084, Australia; (Y.T.); (V.C.); (B.R.); (F.T.)
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Schwarz CM, Hoffmann M, Schwarz P, Kamolz LP, Brunner G, Sendlhofer G. A systematic literature review and narrative synthesis on the risks of medical discharge letters for patients' safety. BMC Health Serv Res 2019; 19:158. [PMID: 30866908 PMCID: PMC6417275 DOI: 10.1186/s12913-019-3989-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background The medical discharge letter is an important communication tool between hospitals and other healthcare providers. Despite its high status, it often does not meet the desired requirements in everyday clinical practice. Occurring risks create barriers for patients and doctors. This present review summarizes risks of the medical discharge letter. Methods The research question was answered with a systematic literature research and results were summarized narratively. A literature search in the databases PubMed and Cochrane Library for Studies between January 2008 and May 2018 was performed. Two authors reviewed the full texts of potentially relevant studies to determine eligibility for inclusion. Literature on possible risks associated with the medical discharge letter was discussed. Results In total, 29 studies were included in this review. The major identified risk factors are the delayed sending of the discharge letter to doctors for further treatments, unintelligible (not patient-centered) medical discharge letters, low quality of the discharge letter, and lack of information as well as absence of training in writing medical discharge letters during medical education. Conclusions Multiple risks factors are associated with the medical discharge letter. There is a need for further research to improve the quality of the medical discharge letter to minimize risks and increase patients’ safety.
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Affiliation(s)
- Christine Maria Schwarz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Magdalena Hoffmann
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria. .,Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1/3, 8036, Graz, Austria.
| | - Petra Schwarz
- Carinthia University of Applied Science, Feldkirchen, Austria
| | - Lars-Peter Kamolz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1/3, 8036, Graz, Austria
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A dual intervention in geriatric patients to prevent drug-related problems and improve discharge management. Int J Clin Pharm 2018; 40:1189-1198. [PMID: 30051223 DOI: 10.1007/s11096-018-0643-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 01/28/2023]
Abstract
Background Drug-related problems (DRPs) endanger geriatric patients' safety. Especially a follow-up treatment with increased number of care transitions is a critical time for patients. Objective This study aimed at optimising medication therapy and the transfer of medication-related information to ambulatory care in geriatric rehabilitation patients. Setting German geriatric rehabilitation centre (GRC). Method A prospective, controlled intervention study was performed. Patients in the control group (CG) received standard care, those in the intervention group (IG) an additional dual pharmaceutical intervention: (i) medication review to optimise in-hospital medication and (ii) improvement of discharge letters for optimising transfer of medication-related information. Main outcome measure (i) Number of patients with at least one DRP at discharge and (ii) predefined quality criteria for the discharge letters. Results 150 patients were enrolled in CG and 163 in IG. (i) At discharge, 126 (84%) patients in the CG were affected by at least one DRP. In the IG, the number of affected patients decreased to 64 (39%, P < 0.05). (ii) In comparison to discharge letters in the CG, predefined quality criteria were improved in the IG. Following differences were measured (CG vs. IG, each P < 0.05): active ingredient indicated (60 vs. 99%), brand name indicated (60 vs. 96%), explanation of medication changes (47 vs. 68%), visualisation of explanations next to the discharge medication (26 vs. 91%) and recommended therapy duration for short-term medications (49 vs. 84%). Conclusion DRPs and incomplete discharge letters affected many patients. The dual intervention improved in-hospital medication therapy and optimised the transfer of medication-related information.
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Caleres G, Strandberg EL, Bondesson Å, Midlöv P, Modig S. Drugs, distrust and dialogue -a focus group study with Swedish GPs on discharge summary use in primary care. BMC FAMILY PRACTICE 2018; 19:127. [PMID: 30045692 PMCID: PMC6060535 DOI: 10.1186/s12875-018-0804-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/21/2018] [Indexed: 12/02/2022]
Abstract
Background Discharge summary with medication report effectively counteracts drug-related problems due to insufficient information transfer in care transitions. The benefits of the discharge summary may be lost if it is not adequately used, and factors affecting optimal use by the GP are of interest. Since the views of Swedish GPs are unexplored, this study aimed to explore and understand GPs experiences, perceptions and feelings regarding the use of the discharge summary with medication report. Method This qualitative study was based on four focus group discussion with 18 GPs and resident physicians in family medicine which were performed in 2016 and 2017. A semi-structured interview guide was used. The interviews were transcribed verbatim and analysed using qualitative content analysis. Results The analysis resulted in three final main themes: “Importance of the discharge summary”, “Role of the GP” and “Create dialogue” with six categories; “Benefits for the GP and perceived benefits for the patient”, “GP use of the information”, “Significance of different documents”, “Spider in the web”, “Terminus/End station” and “Improved information transfer in care transitions”. Overall, the participants described clear benefits with the discharge summary when accurate although perceived deficiencies were also quite rife. Conclusion The GPs experiences and views of the discharge summary revealed clear benefits regarding mainly medication information, awareness of any plans as well as shared knowledge with the patient. However, perceived deficiencies of the discharge summary affected its use by the GP and enhanced communication was called for.
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Affiliation(s)
- Gabriella Caleres
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden.
| | - Eva Lena Strandberg
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden
| | - Åsa Bondesson
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, Kristianstad, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden
| | - Sara Modig
- Department of Clinical Sciences in Malmö/Family Medicine, Center for Primary Health Care Research, Lund University, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, Kristianstad, Sweden
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