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Mahera M, Rodda H, Monypenny N, Wembridge P. Evaluating an implementation of the Australian National Guidelines for the On-Screen Display of Discharge Summaries. AUST HEALTH REV 2023; 47:535-544. [PMID: 37550180 DOI: 10.1071/ah22248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
Objective The objective of this study was to evaluate changes in the inclusion of pertinent information on electronic discharge summaries (eDS) after implementation of a revised template and electronic medical record (EMR) workflow. Methods A retrospective medical record audit of eDS at three metropolitan hospitals was undertaken for adult inpatient encounters in June 2021 (pre-intervention, n = 100) and June 2022 (post-intervention, n = 100). The eDS were evaluated against 16 components listed in the Australian National Guidelines for the On-Screen Display of Discharge Summaries. Nine components were further broken down to between two and 11 sub-components. Sub-analysis compared a hospital with full EMR to pooled results from hospitals with hybrid EMRs. Components and sub-components were evaluated for inclusion only; accuracy or relevance of the information was not assessed. Results Inclusion of three out of 16 components (presentation details: 47% vs 62%, problems and diagnosis: 61% vs 86% and recipient details: 82% vs 93%) and eight out of 36 sub-components (discharge destination, principal diagnosis, history of presenting complaint, infection risk, pressure injury, screening and/or diagnosis of delirium and GP phone number and address) was higher in the post-intervention group (all P < 0.05). Reduced eDS information inclusion in the post-intervention group was observed for discharge date and falls risk only (both P < 0.05). Reporting of falls history decreased at the hospital with full EMR (71% vs 20% P < 0.001) but not at hospitals utilising hybrid EMRs (24% vs 30% P = 0.5). Conclusion The intervention was associated with improved inclusion of pertinent information as described in the Australian National Guidelines for the On-Screen Display of Discharge Summaries.
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Affiliation(s)
- Masarrat Mahera
- Monash University Eastern Health Clinical School, Box Hill, Vic. 3128, Australia
| | - Hamish Rodda
- eHealth Department, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia; and Emergency Department, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia
| | - Nick Monypenny
- eHealth Department, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia
| | - Paul Wembridge
- Department of Quality, Planning and Innovation, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia; and Pharmacy Department, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia
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2
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Chakravarthy R, Shahid M, Basha K M, Angadi SP, Sherikar N. An Audit of Orthopaedic Discharge Summaries Comparing Electronic With Handwritten Summaries: A Quality Improvement Project. Cureus 2023; 15:e39396. [PMID: 37362517 PMCID: PMC10286848 DOI: 10.7759/cureus.39396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Discharge summaries (DS), which are sent from inpatient to outpatient settings, transmit critical clinical information. DS play a crucial role in the discharge process since they provide critical information about the patients that is simple to remember and help with patient follow-up in the community. This audit sought to determine if a quality improvement (QI) program may have an influence on the severity of mistakes at the moment of discharge and to assess the existing degree of inconsistencies on handwritten DS for orthopaedic patients. Methodology From the orthopaedics department at a tertiary care facility in south India, 100 handwritten DS and 100 electronic DS over six months were randomly chosen, and they were retrospectively audited against a predetermined set of criteria. The errors were compiled and compared by three reviewers. Results Some of the criteria, such as the doctor's signature, the speciality of admission, procedural therapy at the hospital, and the date of admission, were contained in all handwritten and electronic DS. Some of the metrics showed that electronic DS performed better than handwritten DS in areas such as hospital complications, which increased from 50% to 100%, contact information, which increased from 34% to 95%, and condition at discharge, which increased from 66% to 96%. Also, understandability increased from 58% to 100%, prognostic details increased from 70% to 96%, allergies increased from 66% to 100%, physical examination findings increased from 88% to 100%, admission diagnosis increased from 80% to 100%, patient/physician details increased from 92% to 100%, the information given to patient increased from 88% to 100%, problem list/issue pending increased from 35% to 92%, investigation increased from 80% to 100%, discharge medications increased from 88% to 100%, follow-up plan increased from 80% to 100%, discharge diagnosis increased from 94% to 100%, International Classification of Diseases, Tenth Revision (ICD-10) code increased from 93% to 100%, and days of admission increased from 92% to 100%. Conclusion Following the deployment of electronic DS, we were able to better care for patients and lessen their discomfort. We advise converting to electronic DS to enhance patient care and better record-keeping since this will become a significant problem if all notes are not accurately filled and are not readable.
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Affiliation(s)
- Rakshith Chakravarthy
- Orthopaedics, MVJ (MV Jayaraman) Medical College and Research Hospital, Bangalore, IND
| | - Mohammed Shahid
- Orthopaedics, MVJ (MV Jayaraman) Medical College and Research Hospital, Bangalore, IND
| | - Moinuddin Basha K
- Orthopaedics, MVJ (MV Jayaraman) Medical College and Research Hospital, Bangalore, IND
| | - Sachin P Angadi
- Orthopaedics, MVJ (MV Jayaraman) Medical College and Research Hospital, Bangalore, IND
| | - Nagesh Sherikar
- Orthopaedics, MVJ (MV Jayaraman) Medical College and Research Hospital, Bangalore, IND
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3
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Schwarz CM, Hoffmann M, Smolle C, Eiber M, Stoiser B, Pregartner G, Kamolz LP, Sendlhofer G. Structure, content, unsafe abbreviations, and completeness of discharge summaries: A retrospective analysis in a University Hospital in Austria. J Eval Clin Pract 2021; 27:1243-1251. [PMID: 33421263 PMCID: PMC9290607 DOI: 10.1111/jep.13533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVE The discharge summary (DS) is one of the most important instruments to transmit information to the treating general physician (GP). The objective of this study was to analyse important components of DS, structural characteristics as well as medical and general abbreviations. METHOD One hundred randomly selected DS from five different clinics were evaluated by five independent reviewers regarding content, structure, abbreviations and conformity to the Austrian Electronic Health Records (ELGA) using a structured case report form. Abbreviations of all 100 DS were extracted. All items were scored on a 4-point Likert-type scale ranging from "strongly agree" to "strongly disagree" (or "not relevant"). Subsequently, the results were discussed among reviewers to achieve a consensus decision. RESULTS The mandatory fields, reason for admission and diagnosis at discharge were present in 80% and 98% of DS. The last medication was fully scored in 48% and the recommended medication in 94% of 100 DS. There were significant overall differences among clinics for nine mandatory items. In total, 750 unexplained abbreviations were found in 100 DS. CONCLUSIONS In conclusion, DS are often lacking important items. Particularly important are a detailed medication history and recommendations for further medication that should always be listed in each DS. It is thus necessary to design and implement changes that improve the completeness of DS. An important quality improvement can be achieved by avoiding the use of ambiguous abbreviations.
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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, Graz, Austria.,Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christian Smolle
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Michael Eiber
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Bianca Stoiser
- Department of Management, Health Management in Tourism, University of Applied Sciences, Bad Gleichenberg, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics und Documentation, Medical University of Graz, Graz, 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
| | - 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, Graz, Austria
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4
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Potent K, Levy B, Porritt A. Review of electronic discharge summaries from the general medicine, general surgery and mental health streams at a tertiary hospital: retrospective analysis of timeliness, brevity and completeness. AUST HEALTH REV 2021; 44:699-705. [PMID: 32962797 DOI: 10.1071/ah19057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 02/10/2020] [Indexed: 11/23/2022]
Abstract
Objective This retrospective study identified and compared the performance of electronic discharge summaries (EDSs) from three hospital in-patient streams (surgical, medical and mental health) with Australian standards. Methods An audit was performed of 120 EDSs extracted from a tertiary hospital. Auditors evaluated each EDS using an adaptation of the Australian Commission on Safety and Quality in Health Care's EDS toolkit. Results EDSs from all in-patient streams were lengthy and most did not include information regarding discharge destination, patient education or recommendations. General Medicine EDSs were most timely, averaging within 1 day of discharge. Conclusions Key areas of improvement remain for improving the timeliness, brevity and completeness of EDSs. Key areas identified for improvement include page length, discharge destination, alerts, patient education and recommendations. Variability in audit results between streams suggests the need for speciality-specific templates, standards and medical officer training. What is known about the topic? The literature suggests that an EDS is timely if it is completed within 2 days of discharge. A complete and brief EDS should also include key details of the care in two (or fewer) pages. What does this paper add? This paper evaluated 120 EDSs, compared them against a standard and stratified the EDSs according to three core clinical in-patient streams that produced them (surgical, medical and mental health). What are the implications for practitioners? Although broad guidelines for timeliness, brevity and completeness have been established for EDSs, each in-patient stream will require different standards. A hospital or health service should have established standards relevant to each in-patient stream. Before commencing a term in any of the three in-patient streams, medical officers who are to generate EDSs should be trained in the required standard. Training should highlight critical elements of a speciality stream to ensure EDS authors are aware of the nuances of the stream in which they are rotating. In addition, general practitioners should liaise with local hospitals to ensure ongoing dialogue and improvement of clinical handover documents.
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Affiliation(s)
- Keith Potent
- School of Medicine, Griffith University, Parklands Drive, Southport, Qld 4215, Australia; and Corresponding author.
| | - Benjamin Levy
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
| | - Andrew Porritt
- School of Medicine, University of Notre Dame Australia (Fremantle), 38/40 Henry Street, Fremantle, WA 6160, Australia; and Present address: Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia.
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Millares Martin P. Non-systematic review: Correspondence quality and interoperability between family physicians and hospital clinicians. Int J Clin Pract 2021; 75:e13984. [PMID: 33484081 DOI: 10.1111/ijcp.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Medical correspondence between physicians working in the community and in hospital is paramount to provide continuity of care, but there is no agreement on what constitutes a good quality letter, not even interest by some clinicians on this interface. Information flow could be faster electronically rather than in paper, but is content improving? What defines a good letter? AIM (a) To assess what information should be shared between family doctors and hospital physicians and could it be shared better. (b) To assess the possibility of linking the sections of the letter to SNOMED-CT codes to improve interoperability. RESULTS Authors vary regarding what is to be included in communications, and as they also have different needs among services, it creates a very long list of possible items to consider. Standardised templates with their corresponding SNOMED-CT codes are presented. CONCLUSION Standardised correspondence could improve continuity of care. Appropriately coded it could facilitate the information sharing and the data manipulation required to provide an adequate provision of services among primary care or family physicians and hospitals or secondary care organisations. It could also serve as a tool to assess clinicians' performance.
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Svensberg K, Trapnes E, Nguyen D, Hasan RA, Sund JK, Mathiesen L. Patients' perceptions of medicines information received at hospital discharge in Norway: a qualitative interview study. Int J Clin Pharm 2021; 43:144-153. [PMID: 32794036 PMCID: PMC7878245 DOI: 10.1007/s11096-020-01122-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022]
Abstract
Background Insufficient transfer of medicines information is a common challenge at discharge from hospital. Following discharge, home dwelling patients are expected to manage their medicines themselves and adequate counselling is an important prerequisite for patient empowerment and self-efficacy for medicines management. Objective The aim was to identify patients' needs for medicines information after discharge from hospital, including the patients' perception and appraisal of the information they received at discharge. Setting The study enrolled patients discharged from three medical wards at a secondary care hospital in Oslo, Norway. Method Patients were included at the hospital, at or close to the day of discharge and qualitative, semi-structured interviews were performed during the first 2 weeks after discharge. Eligible patients were receiving medicines treatment on admission and after discharge, were handling the medicines themselves, and discharged to their own home. Data were collected in 2017. Interviews were analysed with thematic analysis inspired by Systematic Text Condensation. Main outcome measure Patients' perceptions of medicines information. Results In total, 12 patients were interviewed. They were discharged in equal numbers from the three wards, representing both sexes and a broad age range. Patients perceive medicines information as a continuum and not limited to specific encounters, like the discharge conversation. They gain information in several ways; by receiving information from health care professionals, through observations, and by seeking it themselves. Some thought they could have been better informed about adverse reactions and how to manage life while being a medicines user. Others felt they did not want or need more information. Patients employ various strategies for coping with their use of medicines, influencing their self-efficacy towards medicine management. Conclusion Medicines information should focus on empowering the patients throughout the hospital stay and not solely at discharge, taking into account the individual patient's needs for information, preferences and prior knowledge.
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Affiliation(s)
- K Svensberg
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Pharmacy, Section for Pharmaceutics and Social Pharmacy, University of Oslo, Oslo, Norway
| | - E Trapnes
- Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
| | - D Nguyen
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
| | - R A Hasan
- Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - J K Sund
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Central Norway Hospital Pharmacy Trust, Trondheim, Norway
| | - L Mathiesen
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway.
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Gowda NR, Kumar A, Arya SK, H V. The information imperative: to study the impact of informational discontinuity on clinical decision making among doctors. BMC Med Inform Decis Mak 2020; 20:175. [PMID: 32723340 PMCID: PMC7388506 DOI: 10.1186/s12911-020-01190-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background Informational discontinuity can have far reaching consequences like medical errors, increased re-hospitalization rates and adverse events among others. Thus the holy grail of seamless informational continuity in healthcare has been an enigma with some nations going the digital way. Digitization in healthcare in India is fast catching up. The current study explores the components of informational continuity, its impact on clinical decision-making and captures the general perception among the doctors towards a digital solution. Methods Cross-sectional study with snowball sampling. A survey questionnaire was developed and validated through a pilot study, then circulated through online platforms. Responses from doctors were obtained through an online Google form for a period of 3 months and analyzed using SPSS 20. The categorical variables were analyzed using Chi-square test. Results 1413 responses were obtained through a national level survey. Respondents were from a wide range of work experiences, locations, sectors, specialties and patient load. Components of patient records like clinical notes, investigation reports, previous diagnosis and treatment details were rated to be very important. 41% reported about half and 20% reported about 3/4th of their patients do not bring relevant records. Patients from rural areas, visiting state government hospitals and visiting general practitioners were less likely to bring relevant records during consultations. The fallouts of not having timely relevant patient information of the patients include more time per patient, repeat investigations, difficulty to arrive at definitive diagnosis, difficulty to take further treatment decisions and impaired overall clinical decision making which were said to be significant by respondents across the spectrum. The benefits of having timely relevant patient information were also reported consistently across the spectrum. An overwhelming proportion (83%), from across the spectrum, unequivocally expressed their willingness to use digital platforms for accessing patients’ relevant medical records. Conclusion Prevalence of informational discontinuity and its impact on clinical decision making is significant with definite benefits of having timely relevant medical history. There is strong willingness among the doctors to use digital solution(s) without any extra investment or effort on their part making customized solutions pertinent.
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Affiliation(s)
- Naveen R Gowda
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Atul Kumar
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), New Delhi, India. .,ESIC Hospital & Dental College, New Delhi, 110085, India.
| | - Sanjay K Arya
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vikas H
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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8
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Säfström E, Nasstrom L, Liljeroos M, Nordgren L, Årestedt K, Jaarsma T, Stromberg A. Patient Continuity of Care Questionnaire in a cardiac sample: A Confirmatory Factor Analysis. BMJ Open 2020; 10:e037129. [PMID: 32641363 PMCID: PMC7342470 DOI: 10.1136/bmjopen-2020-037129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Even though continuity is essential after discharge, there is a lack of reliable questionnaires to measure and assess patients' perceptions of continuity of care. The Patient Continuity of Care Questionnaire (PCCQ) addresses the period before and after discharge from hospital. However, previous studies show that the factor structure needs to be confirmed and validated in larger samples, and the aim of this study was to evaluate the psychometric properties of the PCCQ with focus on factor structure, internal consistency and stability. DESIGN A psychometric evaluation study. The questionnaire was translated into Swedish using a forward-backward technique and culturally adapted through cognitive interviews (n=12) and reviewed by researchers (n=8). SETTING Data were collected in four healthcare settings in two Swedish counties. PARTICIPANTS A consecutive sampling procedure included 725 patients discharged after hospitalisation due to angina, acute myocardial infarction, heart failure or atrial fibrillation. MEASUREMENT To evaluate the factor structure, confirmatory factor analyses based on polychoric correlations were performed (n=721). Internal consistency was evaluated by ordinal alpha. Test-retest reliability (n=289) was assessed with intraclass correlation coefficient (ICC). RESULTS The original six-factor structure was overall confirmed, but minor refinements were required to reach satisfactory model fit. The standardised factor loadings ranged between 0.68 and 0.94, and ordinal alpha ranged between 0.82 and 0.95. All subscales demonstrated satisfactory test-retest reliability (ICC=0.76-0.94). CONCLUSION The revised version of the PCCQ showed sound psychometric properties and is ready to be used to measure perceptions of continuity of care. High ordinal alpha in some subscales indicates that a shorter version of the questionnaire can be developed.
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Affiliation(s)
- Emma Säfström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Lena Nasstrom
- Research and Development Unit, Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden
| | - Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Lena Nordgren
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Kristofer Årestedt
- Faculty of health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Cardiology, Linköping University Hospital, Linkoping, Sweden
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9
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Bishop A, Curran J, Rose H, McKibbon S. Strategies for communicating patient health information between emergency and primary care settings: a scoping review protocol. ACTA ACUST UNITED AC 2019; 16:1317-1322. [PMID: 29894398 DOI: 10.11124/jbisrir-2017-003492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The objective of this scoping review is to explore strategies being used to communicate patient information between emergency and primary care settings. This information will be used as a first step to develop an intervention to improve information exchange and communication between emergency and primary care providers.Specifically the review questions are:i) What tools and strategies are being used to support the communication and exchange of patient information between emergency and primary care settings?ii) What models/frameworks are being used to guide the development of these strategies and tools?iii) What are the identified barriers to exchanging patient information between emergency and primary care settings?iv) What are the outcomes measures reported in these studies?
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Affiliation(s)
- Andrea Bishop
- School of Nursing, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change: a Joanna Briggs Institute Center of Excellence
| | - Janet Curran
- School of Nursing, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change: a Joanna Briggs Institute Center of Excellence
| | - Heather Rose
- Department of Emergency Medicine, IWK Health Centre, Halifax, Canada
| | - Shelley McKibbon
- WK Kellogg Health Sciences Library, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change: a Joanna Briggs Institute Center of Excellence
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Huang LYI, Fogarty SJ, Ng ACT, Wang WYS. Rates and predictors of general practitioner (GP) follow-up postdischarge from a tertiary hospital cardiology unit: a retrospective cohort study. BMJ Open 2019; 9:e031627. [PMID: 31666271 PMCID: PMC6830598 DOI: 10.1136/bmjopen-2019-031627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Previous studies in cardiac patients noted that early patient follow-up with general practitioners (GPs) after hospital discharge was associated with reduced rates of hospital readmissions. We aimed to identify patient, clinical and hospital factors that may influence GP follow-up of patients discharged from a tertiary cardiology unit. DESIGN Single centre retrospective cohort study. SETTING Australian metropolitan tertiary hospital cardiology unit. PARTICIPANTS 1079 patients discharged from the hospital cardiology unit within 3 months from May to July 2016. OUTCOME MEASURES GP follow-up rates (assessed by telephone communication with patients' nominated GP practices), demographic, clinical and hospital factors predicting GP follow-up. RESULTS We obtained GP follow-up data on 983 out of 1079 (91.1%) discharges in the study period. Overall, 7, 14 and 30-day GP follow rates were 50.3%, 66.5% and 79.1%, respectively. A number of patient, clinical and hospital factors were associated with early GP follow-up, including pacemaker and defibrillator implantation, older age and having never smoked. Documented recommendation for follow-up in discharge summary was the strongest predictor for 7-day follow-up (p<0.001). CONCLUSION After discharge from a cardiology admission, half of the patients followed up with their GP within 7 days and most patients followed up within 30 days. Patient and hospital factors were associated with GP follow-up rates. Identification of these factors may facilitate prospective interventions to improve early GP follow-up rates.
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Affiliation(s)
- Luke Y I Huang
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Samuel J Fogarty
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - William Y S Wang
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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11
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Patients with Clinically Suspected but Unproven Hip Fractures, Who Require Cross-Sectional Imaging, Are Best Initially Admitted under Geriatrician-Led Care-A Retrospective Review. Geriatrics (Basel) 2018; 3:geriatrics3040068. [PMID: 31011103 PMCID: PMC6371149 DOI: 10.3390/geriatrics3040068] [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: 09/14/2018] [Revised: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 11/17/2022] Open
Abstract
Patients with suspected hip fractures who require further imaging to confirm or disprove the diagnosis may be admitted to orthopaedic or medical departments. We aim to provide evidence regarding the appropriate admission pathway for such patients. This is a retrospective study of all suspected hip fracture patients receiving second-line imaging between 1 January 2015 to 30 June 2016 in one hospital trust. Information was gained from hospital records to determine indication and result of imaging, eventual diagnoses, length of stay, and inpatient mortality. During the study period, 126 patients underwent cross-sectional imaging for clinically suspected but unproven hip fractures. Of these, 27% were positive for hip fractures (n = 34, 3.2% of hip fracture admissions) whilst the remainder were negative. Of the patients without hip fractures, 50 (54%) had a concomitant medical discharge diagnosis. Thirty-one different diagnoses were found in this cohort. This research provides evidence for geriatrician-led admission of patients with suspected but unproven hip fracture, due to the frailty and medical requirements of this patient group.
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12
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Cheng DR, Katz ML, South M. Integrated Electronic Discharge Summaries-Experience of a Tertiary Pediatric Institution. Appl Clin Inform 2018; 9:734-742. [PMID: 30231259 DOI: 10.1055/s-0038-1669461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Succinct and timely discharge summaries (DSs) facilitate ongoing care for patients discharged from acute care settings. Many institutions have introduced electronic DS (eDS) templates to improve quality and timeliness of clinical correspondence. However, significant intrahospital and intraunit variability and application exists. A review of the literature and guidelines revealed 13 key elements that should be included in a best practice DS. This was compared against our pediatric institution's eDS template-housed within an integrated electronic medical record (EMR) and used across most inpatient hospital units. METHODS Uptake and adherence to the suggested key elements was measured by comparing all DSs for long stay inpatients (> 21-day admission) during the first year of the EMR eDS template's usage (May 2016-April 2017). RESULTS A total of 472 DSs were evaluated. Six of 13 key elements were completed in > 98.0% of DSs. Conversely, only < 5.0% included allergies or adverse reaction data, and < 11.0% included ceased medications or pending laboratory results. Inclusion of procedure information and pending laboratory results significantly improved with time (p = 0.05 and p < 0.04, respectively), likely as doctors became more familiar with EMR and autopopulation functions. Inclusion of "discharge diagnosis" differed significantly between medical (n = 406/472; 99.0%) and surgical (n = 32/472; 51.6%) DSs. CONCLUSION Uptake and adherence to an EMR eDS template designed to meet best practice guidelines in a pediatric institution was strong, although significant improvements in specific data elements are needed. Strategies can include a modification of existing eDS templates and junior medical staff education around best practice.
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Affiliation(s)
- Daryl R Cheng
- EMR Project Team, The Royal Children's Hospital Melbourne, Parkville, Australia.,Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Merav L Katz
- EMR Project Team, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Mike South
- EMR Project Team, The Royal Children's Hospital Melbourne, Parkville, Australia.,Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
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13
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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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14
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Bernal JL, DelBusto S, García-Mañoso MI, de Castro Monteiro E, Moreno Á, Varela-Rodríguez C, Ruiz-lopez PM. Impact of the implementation of electronic health records on the quality of discharge summaries and on the coding of hospitalization episodes. Int J Qual Health Care 2018; 30:630-636. [DOI: 10.1093/intqhc/mzy075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/03/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- José L Bernal
- Management Control Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sebastián DelBusto
- Service of Preventive Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María I García-Mañoso
- Service of Preventive Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Ángel Moreno
- Patient Management and Clinical Documentation Service, Hospital Universitario 12 de Octubre, Madrid, Spain
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15
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Crossan I, Curtis D, Ong YL. Audit of psychiatric discharge summaries: completing the cycle. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.28.9.329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo examine and attempt to improve the recording of information within psychiatric discharge summaries in an adult psychiatry department, by means of audit and feedback. Psychiatric discharge summaries from an acute adult psychiatric department were examined to determine the recording of ten selected items. Following feedback and discussion, the audit was repeated after 6 months.ResultsFifty-one discharge summaries were examined on the first occasion and 53 on the second. There was considerable variability in the standard of recording across the selected items, but the patterns of recording were similar at both stages. No improvement was found in the recording of information at the second audit.Clinical ImplicationsAudit and feedback alone may have little effect in changing clinical practice. This study examines the experience of undertaking clinical audit from a trainee's perspective, illustrates barriers to change and highlights the possible limitations of audit as a clinical tool.
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16
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Mills PR, Weidmann AE, Stewart D. Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation. Int J Clin Pharm 2017; 39:1320-1330. [PMID: 29076013 PMCID: PMC5694510 DOI: 10.1007/s11096-017-0543-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/26/2017] [Indexed: 11/30/2022]
Abstract
Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information.
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Affiliation(s)
- Pamela Ruth Mills
- Pharmacy Department, University Hospital Crosshouse, Kilmarnock, Ayrshire, Scotland, KA2 0BE, UK.
| | - Anita Elaine Weidmann
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, AB10 7GJ, UK
| | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, AB10 7GJ, UK
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17
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Mantzourani E, Way CM, Hodson KL. Does an integrated information technology system provide support for community pharmacists undertaking Discharge Medicines Reviews? An exploratory study. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2017; 6:145-156. [PMID: 29354561 PMCID: PMC5774314 DOI: 10.2147/iprp.s133273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the views of community pharmacists participating in the pilot of a secure online platform in Wales, the Choose Pharmacy application (CPA), with particular interest in the electronic Discharge Advice Letters (e-DALs) and online Discharge Medicines Review (DMR) form. Materials and methods A qualitative approach with semi-structured interviews was adopted. A gatekeeper from National Health Service Wales Informatics Service identified 35 pharmacies, of the 43 pharmacies where the CPA had been implemented, that had completed at least one DMR, and these were therefore invited to an interview. Results A total of 17 pharmacists were interviewed. Overall, the results were positive and CPA and e-DAL were perceived to facilitate continuity of care between care settings. The design and usability were perceived as good as pharmacists could navigate the CPA without problems; many felt this was due to the level of training they had received. Many pharmacists were happy for other services to be included on the platform due to its ease of use and automatic reimbursement. Several pharmacists felt that communication between primary and secondary care can be further improved as the uptake of e-DAL increases. Conclusion CPA was found to streamline the completion of online DMR improving continuity of care between primary and secondary sectors, which in turn should improve patient safety on discharge from hospital.
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Affiliation(s)
- Efthymia Mantzourani
- College of Biomedical and Life Sciences, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University
| | - Cheryl M Way
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | - Karen L Hodson
- College of Biomedical and Life Sciences, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University
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18
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Sayyah-Melli M, Nikravan Mofrad M, Amini A, Piri Z, Ghojazadeh M, Rahmani V. The Effect of Medical Recording Training on Quantity and Quality of Recording in Gynecology Residents of Tabriz University of Medical Sciences. J Caring Sci 2017; 6:281-292. [PMID: 28971078 PMCID: PMC5618952 DOI: 10.15171/jcs.2017.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 01/22/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction: Medical records contain valuable information
about a patient's medical history and treatment. Patient safety is one of the most
important dimensions of health care quality assurance and performance improvement.
Completing the process of documentation is necessary to continue patient care and
continuous quality improvement of basic services. The aim of the present study was to
evaluate the effect of medical recording education on the quantity and quality of
recording in gynecology residents of Tabriz University of Medical Sciences. Methods: This study is a quasi-experimental study and was
conducted at Al-Zahra Teaching Hospital, Tabriz, Iran, in 2016. Thirty-two second through
fourth year gynecologic residents of Tabriz University of Medical Sciences who were
willing to participate in the study were included by census sampling and participated in
training workshop. Three evaluators reviewed the residents’ records before and after
training course by a checklist. Statistical analyses were performed using SPSS 13
software. P-values less than 0.05 were considered statistically significant. Results: The results showed that before the intervention,
there were significant differences in the quantity of information status among the
evaluators and no significant difference was observed in the recording of qualitative
status. After the workshop, among the 3 evaluators, there were also significant
differences in the quantity of data recording status; however, no significant change was
observed in recording of qualitative status. Conclusion: The study findings revealed that a sectional
training course of correct and standardized medical records has no effect on reforming the
process of recording.
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Affiliation(s)
- Manizheh Sayyah-Melli
- Departement of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, School of Medical Education, Tehran, Iran.,Research Center of Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Malahat Nikravan Mofrad
- Departement of Nursing, School of Nursing & Midwifery, School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolghasem Amini
- Department and Center for Educational Research and Development (EDC), Tabriz University of Medical Science, Tabriz, Iran
| | - Zakieh Piri
- Department of Medical Records, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center of Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahideh Rahmani
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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19
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Goldsmith H, Curtis K, McCloughen A. Effective pain management in recently discharged adult trauma patients: Identifying patient and system barriers, a prospective exploratory study. J Clin Nurs 2017; 26:4548-4557. [DOI: 10.1111/jocn.13792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Helen Goldsmith
- Sydney Nursing School; University of Sydney; Sydney NSW Australia
- Trauma Service; St George Hospital; Sydney NSW Australia
| | - Kate Curtis
- Sydney Nursing School; University of Sydney; Sydney NSW Australia
- Trauma Service; St George Hospital; Sydney NSW Australia
- Faculty of Medicine; St George Clinical School; University of New South Wales; Sydney NSW Australia
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20
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Phipps DL, Morris RL, Blakeman T, Ashcroft DM. What is involved in medicines management across care boundaries? A qualitative study of healthcare practitioners' experiences in the case of acute kidney injury. BMJ Open 2017; 7:e011765. [PMID: 28100559 PMCID: PMC5253539 DOI: 10.1136/bmjopen-2016-011765] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To examine the role of individual and collective cognitive work in managing medicines for acute kidney injury (AKI), this being an example of a clinical scenario that crosses the boundaries of care organisations and specialties. DESIGN Qualitative design, informed by a realist perspective and using semistructured interviews as the data source. The data were analysed using template analysis. SETTING Primary, secondary and intermediate care in England. PARTICIPANTS 12 General practitioners, 10 community pharmacists, 7 hospital doctors and 7 hospital pharmacists, all with experience of involvement in preventing or treating AKI. RESULTS We identified three main themes concerning participants' experiences of managing medicines in AKI. In the first theme, challenges arising from the clinical context, AKI is identified as a technically complex condition to identify and treat, often requiring judgements to be made about renal functioning against the context of the patient's general well-being. In the second theme, challenges arising from the organisational context, the crossing of professional and organisational boundaries is seen to introduce problems for the coordination of clinical activities, for example by disrupting information flows. In the third theme, meeting the challenges, participants identify ways in which they overcome the challenges they face in order to ensure effective medicines management, for example by adapting their work practices and tools. CONCLUSIONS These themes indicate the critical role of cognitive work on the part of healthcare practitioners, as individuals and as teams, in ensuring effective medicines management during AKI. Our findings suggest that the capabilities underlying this work, for example decision-making, communication and team coordination, should be the focus of training and work design interventions to improve medicines management for AKI or for other conditions.
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Affiliation(s)
- Denham L Phipps
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, The University of Manchester, Manchester, UK
| | - Rebecca L Morris
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Tom Blakeman
- Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Collaborative for Leadership in Applied Health Reserach and Care, The University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, The University of Manchester, Manchester, UK
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21
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Martin JH, May JA. The challenge of discharge: combining medication reconciliation and discharge planning. Med J Aust 2017; 206:20-21. [PMID: 28076731 DOI: 10.5694/mja16.01157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/26/2016] [Indexed: 11/17/2022]
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Ehnbom EC, Raban MZ, Walter SR, Richardson K, Westbrook JI. Do electronic discharge summaries contain more complete medication information? A retrospective analysis of paper versus electronic discharge summaries. Health Inf Manag 2016; 43:4-12. [PMID: 27009792 DOI: 10.1177/183335831404300301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complete, accurate and timely hospital discharge summaries are important for continuity of care. The aim of this study was to evaluate the effectiveness of an electronic discharge summary system in improving the medication information provided compared to the information in paper discharge summaries. We conducted a retrospective audit of 199 paper and 200 electronic discharge summaries from a 350-bed teaching hospital in Sydney, Australia. The completeness of medication information, and whether medication changes during the admission were explained, were assessed. Further, the likelihood of any incomplete information having an impact on continuity of care was assessed. There were 1352 and 1771 medication orders assessed in paper and electronic discharge summaries, respectively. Of these, 90.9% and 93.4% were complete in paper and electronic discharge summaries, respectively. The dose (OR 25.24, 95%CI: 3.41-186.9) and route (OR 8.65, 95%CI: 3.46-21.59) fields of medication orders, were more likely to be complete in electronic as compared with paper discharge summaries. There was no difference for drug frequency (OR 1.09, 95%CI: 0.77-1.55). There was no significant improvement in the proportion of incomplete medication orders rated as unclear and likely to impede continuity of care in paper compared with electronic discharge summaries (7.3% vs. 6.5%). Of changes to medication regimen, only medication additions were more likely to be explained in the electronic (n=253, 37.2%) compared to paper (n=104, 14.3%) discharge summaries (OR 3.14; 95%CI: 2.20-4.18). In summary, electronic discharge summaries offer some improvements over paper discharge summaries in terms of the quality of medication information documented. However, explanations of changes to medication regimens remained low, despite this being crucial information. Future efforts should focus on including the rationale for changes to medication regimens in discharge summaries.
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Affiliation(s)
- Elin C Ehnbom
- The University of New South Wales UNSW Sydney NSW 2052 Australia
| | - Magdalena Z Raban
- Australian Institute of Health Innovation The University of New South Wales, Sydney NSW
| | - Scott R Walter
- Australian Institute of Health Innovation The University of New South Wales, Sydney NSW 2052
| | | | - Johanna I Westbrook
- Centre for Health Systems and Safety Research Australian Institute of Health Innovation The University of New South Wales, Sydney NSW 2052
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23
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Spaulding A, Gamm L, Menser T. Physician Engagement: Strategic Considerations among Leaders at a Major Health System. Hosp Top 2016; 92:66-73. [PMID: 25226080 DOI: 10.1080/00185868.2014.937970] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The authors utilize qualitative interviews with 38 health administrators at one large metropolitan, multihospital system to help identify perspectives regarding physician engagement. Here they focus on 1) lessons learned from past physician engagement efforts, 2) strategic considerations concerning the engagement of physicians, and 3) recommendations for future action. The authors conclude that current hospital leaders have learned from the failures of the past based on the identification of success factors critical to physician engagement. However, future success may relate directly to the increased attention to criteria by which the organization assesses the success of such engagement.
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24
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Tan B, Mulo B, Skinner M. Discharge documentation improvement project: a pilot study. Intern Med J 2016; 45:1280-5. [PMID: 26348766 DOI: 10.1111/imj.12895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/09/2015] [Accepted: 08/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Discharge summaries remain a critical communication tool with primary care physicians. In a previous study of over 200 general medicine discharge summaries, we demonstrated that only 50% contain information regarding the indication and follow up required of any medicine changes on discharge. AIM In this follow up pilot study, we assess the role of feedback and token incentives in improving discharge documentation. METHODS Over a 14-week period, we randomly audited a selection of discharge summaries on a fortnightly basis. The results of these audits were fed back to the junior medical staff who compiled these summaries. If over 80% of the audited discharge summaries adequately documented the indication, with required follow up for new medication changes, junior doctors were provided with a token, non-monetary incentive for their efforts. At the end of the study period, we then conducted a survey of the junior doctors involved and collected feedback regarding their impressions of the study. RESULTS Over the study period, 722 discharge summaries were completed and eligible for analysis. Over this time, mean appropriate documentation regarding medicine indication improved by 32%, and follow-up documentation improved by 10%. Overall, the participants felt the interventions were beneficial and that they should be continued beyond the study period. CONCLUSIONS Education coupled with regular feedback and non-monetary incentives can potentially lead to improvements in the quality of discharge summaries.
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Affiliation(s)
| | - B Mulo
- Sir Charles Gairdner Hospital, Western Australia, Australia
| | - M Skinner
- Department of General Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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25
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Aziz C, Grimes T, Deasy E, Roche C. Compliance with the Health Information and Quality Authority of Ireland National Standard for Patient Discharge Summary Information: a retrospective study in secondary care. Eur J Hosp Pharm 2016; 23:272-277. [PMID: 31156864 PMCID: PMC6451507 DOI: 10.1136/ejhpharm-2015-000748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 01/01/2016] [Accepted: 01/13/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Unexplained changes to medication are common at hospital discharge and underscore the need to standardise patient discharge clinical documentation. In 2013, the Health Information and Quality Authority in Ireland published a Standard on the structure and content of discharge summaries. The intention was to ensure that all necessary information was complete and communicated to the next care provider. OBJECTIVES This study investigated one Hospital's compliance with the Standard, and appraised two methods of electronic discharge communication (Symphony or Tallaght Education and Audit Management System (TEAMS)). METHOD A retrospective survey of 198 randomly selected discharge summaries was conducted at the study hospital, a 600 bed academic teaching hospital located in Dublin, Ireland. RESULTS Of the 198 evaluated summaries, mean total compliance was 77%±4.2 (95% CI 76.3 to 77.5). Most (84.7%, n=173) summaries were completed using one of the systems (TEAMS). Absence of communication about alteration of preadmission medication was frequent (107 out of 130 patients (82.3%, CI 76.2 to 89.2)). Higher compliance rates were observed however, when information was interfaced or where there were dedicated fields to be completed. CONCLUSIONS Efforts to improve compliance with the National Standard for Patient Discharge Summary Information should focus on reporting changes made to medication during hospitalisation.
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Affiliation(s)
- Claudine Aziz
- Department of Pharmacy, Trinity College Dublin, Dublin, Ireland
| | - Tamasine Grimes
- Department of Pharmacy, Trinity College Dublin, Dublin, Ireland
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - Evelyn Deasy
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - Cicely Roche
- Department of Pharmacy, Trinity College Dublin, Dublin, Ireland
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Craig J, Callen J, Marks A, Saddik B, Bramley M. Electronic Discharge Summaries: The Current State of Play. HEALTH INF MANAG J 2016. [DOI: 10.1177/183335830703600305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The exchange of health information between acute care providers (e.g. hospitals) and primary care providers (e.g. general practitioners) has traditionally been via hard copy discharge summaries. In recent years the advent of sophisticated information and communication technology has fuelled developments in electronic discharge referral systems (eDRS), which are credited with enabling more timely and accurate information exchange, enhancing patient care, and ultimately improving patient outcomes. The aim of this paper is to highlight key issues regarding the development and implementation of electronic discharge referral systems. A detailed literature review of information related to electronic discharge summaries was undertaken for publications between 1992 and 2006. While eDRS appear to be beneficial, further improvements are needed before systems are dependable. Through prospective enhancements and increased availability of eDRS internationally, electronic discharge referral systems have the potential to facilitate effective communication exchange across the primary-secondary care interface.
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27
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Zhao CY, Ang RYN, George R, Tan MH, Murrell DF. The quality of dermatology consultation documentation in discharge summaries: a retrospective analysis. Int J Womens Dermatol 2016; 2:23-27. [PMID: 28491997 PMCID: PMC5412107 DOI: 10.1016/j.ijwd.2015.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 12/01/2022] Open
Abstract
Introduction Good quality documentation of dermatology consults in discharge summaries allows diagnostic and therapeutic plans to be communicated to other health professionals and ensures that appropriate governmental funds are provided to dermatology departments. Methods A retrospective analysis was performed of all dermatology consults seen in 2013 at a public tertiary hospital in Sydney, Australia. Results Two hundred nineteen discharge summaries related to inpatient dermatology consultations were analysed; 80.6% of dermatology consults, 72.2% of skin biopsies, and 57.6% of diagnoses were duly included in the discharge summaries; 82.5% of the discharge summaries were completed before the discharge. The accuracy rate of diagnosis documentation was 54.5% and was correlated with clear dermatology team documentation, the use of a problems list, infectious skin diseases and junior medical staff authorship. Conclusion This study highlights the need for improvement in dermatology consult documentation in discharge summaries. It suggests the use of a problems list in discharge summaries, clarity in dermatology teams’ documentations, and postdischarge follow-up. The quality of dermatology consultation documentation in discharge summaries has opportunities for improvement. The use of a problems list in discharge summaries, clarity in the dermatology team’s documentation, noninfectious skin diseases, and junior medical staff authorship are correlated with superior accuracy in discharge summaries.
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Affiliation(s)
- Cathy Y Zhao
- Department of Dermatology, St George Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Renette Y N Ang
- Department of Dermatology, St George Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Robert George
- Department of Dermatology, St George Hospital, Sydney, Australia
| | - Mei-Heng Tan
- Department of Dermatology, St George Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
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Murphy SF, Lenihan L, Orefuwa F, Colohan G, Hynes I, Collins CG. Electronic discharge summary and prescription: improving communication between hospital and primary care. Ir J Med Sci 2016; 186:455-459. [DOI: 10.1007/s11845-016-1397-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/05/2016] [Indexed: 11/27/2022]
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Uppal NK, Eisen D, Weissberger J, Wyman RJ, Urbach DR, Bell CM. Transfer of care of postsurgical patients from hospital to the community setting: cross-sectional survey of primary care physicians. Am J Surg 2015; 210:778-82. [DOI: 10.1016/j.amjsurg.2015.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/29/2015] [Accepted: 03/03/2015] [Indexed: 11/16/2022]
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Vermeir P, Vandijck D, Degroote S, Ommeslag D, Van De Putte M, Heytens S, Reniers J, Hanoulle I, Peleman R, Vogelaers D. Mutual perception of communication between general practitioners and hospital-based specialists. Acta Clin Belg 2015; 70:350-6. [PMID: 26043268 DOI: 10.1179/2295333715y.0000000032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Communication between general practitioners (GPs) and specialists is an important aspect of qualitative care. Efficient communication exchange is essential and key in guaranteeing continuity of care. Inefficient communication is related to several negative outcomes, including patient harm. This study aimed to investigate the perception of GPs and hospital-based specialists in Belgium of the quality of their mutual communication. METHODS A cross-sectional study was conducted among GPs and specialists. Participants were asked to complete a validated questionnaire on several aspects of their mutual communication. RESULTS Response rates of 17.9% (343/1.912) for GPs and 17.3% (392/2.263) for specialists were obtained. Both specialists and GPs qualify their mutual telephone accessibility as suboptimal. Specialists think poorly of the GP referral letter, in contrast to GP perception. Eighty per cent of the GPs feel that specialists address their questions appropriately; specialists have a similar perception of their own performance. According to 16.7% of the specialists, GPs not always follow their recommendations. Contrarily, GPs rate their compliance much higher (90.7%). Less than half of the GPs feel that the specialists' letter arrives on time, whereas specialists have a different and a more positive perception. CONCLUSIONS GPs and specialists disagree on several aspects of their mutual communication. These include the perception of accessibility, in both directions, and of the timeliness of written communication. Feedback is positively appreciated, again in both directions. Nevertheless, specialists feel that uptake of their recommendations is insufficient. Hence, there may remain significant room for improvement, which could contribute significantly to continuity of care and patient safety.
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Affiliation(s)
- P Vermeir
- Department of General Internal Medicine, Ghent University Hospital , Belgium
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Hammad EA, Wright DJ, Walton C, Nunney I, Bhattacharya D. Adherence to UK national guidance for discharge information: an audit in primary care. Br J Clin Pharmacol 2015; 78:1453-64. [PMID: 25041244 DOI: 10.1111/bcp.12463] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 07/03/2014] [Indexed: 01/10/2023] Open
Abstract
AIMS Poor communication of clinical information between healthcare settings is associated with patient harm. In 2008, the UK National Prescribing Centre (NPC) issued guidance regarding the minimum information to be communicated upon hospital discharge. This study evaluates the extent of adherence to this guidance and identifies predictors of adherence. METHODS This was an audit of discharge summaries received by medical practices in one UK primary care trust of patients hospitalized for 24 h or longer. Each discharge summary was scored against the applicable NPC criteria which were organized into: 'patient, admission and discharge', 'medicine' and 'therapy change' information. RESULTS Of 3444 discharge summaries audited, 2421 (70.3%) were from two teaching hospitals and 906 (26.3%) from three district hospitals. Unplanned admissions accounted for 2168 (63.0%) of the audit sample and 74.6% (2570) of discharge summaries were electronic. Mean (95% CI) adherence to the total NPC minimum dataset was 71.7% [70.2, 73.2]. Adherence to patient, admission and discharge information was 77.3% (95% CI 77.0, 77.7), 67.2% (95% CI 66.3, 68.2) for medicine information and 48.9% (95% CI 47.5, 50.3) for therapy change information. Allergy status, co-morbidities, medication history and rationale for therapy change were the most frequent omissions. Predictors of adherence included quality of the discharge template, electronic discharge summaries and smaller numbers of prescribed medicines. CONCLUSIONS Despite clear guidance regarding the content of discharge information, omissions are frequent. Adherence to the NPC minimum dataset might be improved by using comprehensive electronic discharge templates and implementation of effective medicines reconciliation at both sides of the health interface.
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Affiliation(s)
- Eman A Hammad
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, 11942, Jordan
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Tan B, Mulo B, Skinner M. Transition from hospital to primary care: an audit of discharge summary - medication changes and follow-up expectations. Intern Med J 2015; 44:1124-7. [PMID: 25367726 DOI: 10.1111/imj.12581] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical discharge summary remains a critical, but often poorly implemented tool in communication with primary care. An area of concern is the documentation of medication lists and appropriate follow up of medication changes. AIMS To assesses the accuracy of documentation of medication changes and expectations with regard to follow up from an acute assessment unit (AAU) of a tertiary metropolitan hospital. METHODS All patients who were admitted and discharged directly from the unit during the month of June 2013 were audited. For all admissions, discharge summaries were audited for medication errors and for the appropriate documentation of indications and follow up for prescribed medications. All medications prescribed on discharge were collated using the World Health Organization Anatomical, Therapeutic and Chemical (ATC) classification. RESULTS In total, 219 admissions were analysed. There were 204 out of 219 (93.1%) discharge summaries that had an accurate medication list. Of 219 (74%) patients, 163 had at least one change to their medications during admission. Of 163 discharge summaries, 82 (50%) contained information regarding their indication and outpatient management. The most commonly prescribed classes along with the rates of indication and follow up documentation were anti-infectives (62%), gastrointestinal (51%), cardiovascular (50%) and central nervous system (44%). CONCLUSION Although there were fewer documentation errors in discharge summaries than previously described in the literature, concerns regarding the documentation of medication indication and follow up remain.
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Affiliation(s)
- B Tan
- Department of General Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Unnewehr M, Schaaf B, Marev R, Fitch J, Friederichs H. Optimizing the quality of hospital discharge summaries--a systematic review and practical tools. Postgrad Med 2015; 127:630-9. [PMID: 26074128 DOI: 10.1080/00325481.2015.1054256] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although doctors' discharge summaries (DS) are important forms of communication between the physicians in patient care, deficits in the quality of DS are common. This review aims to answer the following question: according to the literature, how can the quality of DS be improved by (1) interventions; (2) reviews and guidelines of regulatory bodies; and (3) other practical recommendations? METHODS Systematic review of the literature. RESULTS The scientific papers on optimizing the quality of DS (n = 234) are heterogeneous and do not allow any meta-analysis. The interventional studies revealed that a structured approach of writing, educational training including feedback and the use of a checklist are effective methods. Guidelines are helpful for outlining the key characteristics of DS. Additionally, the articles in the literature provided practical proposals on improving form, structure, clinical content, treatment recommendations, follow-up plan, medications and changes, addressees, patient data, length, language, dictation, electronic processing and timeliness of DS. CONCLUSION The literature review revealed various possibilities for improving the quality of DS.
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Affiliation(s)
- Markus Unnewehr
- Klinikum Dortmund gGmbH, Respiratory Medicine, Infectious Diseases, Intensive Care Medicine , Dortmund , Germany
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Mills PR, Weidmann AE, Stewart D. Hospital discharge information communication and prescribing errors: a narrative literature overview. Eur J Hosp Pharm 2015; 23:3-10. [PMID: 31156807 DOI: 10.1136/ejhpharm-2015-000677] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 11/03/2022] Open
Abstract
Objectives To provide a narrative overview of the literature on discharge information communication and medicines discharge prescribing error rate in the UK and other similar healthcare systems. Methods A narrative review of the peer reviewed literature (2000-2014) on communication of discharge information from hospitals to general practitioners. Databases included were MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index and Abstracts, and International Pharmacy Abstracts database. Results The search yielded 673 results with 15 papers satisfying all inclusion criteria. Direct comparison of studies was not feasible due to differences in study populations and outcome measures. No studies reported post Hospital Electronic Prescribing and Medicine Administration (HEPMA) implementation. Studies (n=6) investigating handwritten discharge communication systems demonstrated medicine information inaccuracy ranging from 0.81 errors per patient to 17.5% medicines with errors and 67% letters missing medicines change information; with 77% assessed as legible. Studies (n=4) comparing interim electronic solutions with traditional showed variable results: improved, unchanged or decreased medicine information accuracy. Studies researching solely interim electronic solutions (n=5) with one including prescribing error rate assessment at 8.4% of prescribed items and identification of a new electronic system-related error type. Conclusion Implementation of interim electronic discharge solutions resulted in complete legibility but did not eradicate information and prescribing errors. A paucity of information is available about HEPMA implementation impact on discharge information communication and prescribing error rates. There is urgent need for formal evaluation in this area.
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Affiliation(s)
| | | | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
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Yu K, Nguyen A, Shakib S, Doecke CJ, Boyce M, March G, Anderson BA, Gilbert AL, Angley MT. Enhancing Continuity of Care in Therapeutics: Development of a Post-Discharge Home Medicines Review Model. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2007.tb00652.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Manya T Angley
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia
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Curriculare Übung zum Verfassen von Arztbriefen im vierten Jahr des Medizinstudiums – Einschätzungen der Teilnehmer nach zwei Jahren. Wien Med Wochenschr 2015; 165:86-90. [DOI: 10.1007/s10354-015-0345-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
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Al-Damluji MS, Dzara K, Hodshon B, Punnanithinont N, Krumholz HM, Chaudhry SI, Horwitz LI. Hospital variation in quality of discharge summaries for patients hospitalized with heart failure exacerbation. Circ Cardiovasc Qual Outcomes 2015; 8:77-86. [PMID: 25587091 DOI: 10.1161/circoutcomes.114.001227] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Single-site studies have demonstrated inadequate quality of discharge summaries in timeliness, transmission, and content, potentially contributing to adverse outcomes. However, degree of hospital-level variation in discharge summary quality for patients hospitalized with heart failure (HF) is uncertain. METHODS AND RESULTS We analyzed discharge summaries of patients enrolled in the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) study. We assessed hospital-level performance on timeliness (fraction of summaries completed on the day of discharge), documented transmission to the follow-up physician, and content (presence of components suggested by the Transitions of Care Consensus Conference). We obtained 1501 discharge summaries from 1640 (91.5%) patients discharged alive from 46 hospitals. Among hospitals contributing ≥ 10 summaries, the median hospital dictated 69.2% of discharge summaries on the day of discharge (range, 0.0%-98.0%; P<0.001); documented transmission of 33.3% of summaries to the follow-up physician (range, 0.0%-75.7%; P<0.001); and included 3.6 of 7 Transitions of Care Consensus Conference elements (range, 2.9-4.5; P<0.001). Hospital course was typically included (97.2%), but summaries were less likely to include discharge condition (30.7%), discharge volume status (16.0%), or discharge weight (15.7%). No discharge summary included all 7 Transitions of Care Consensus Conference-endorsed content elements, was dictated on the day of discharge, and was sent to a follow-up physician. CONCLUSIONS Even at the highest performing hospital, discharge summary quality is insufficient in terms of timeliness, transmission, and content. Improvements in all aspects of discharge summary quality are necessary to enable the discharge summary to serve as an effective transitional care tool.
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Affiliation(s)
- Mohammed Salim Al-Damluji
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Kristina Dzara
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Beth Hodshon
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Natdanai Punnanithinont
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Harlan M Krumholz
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Sarwat I Chaudhry
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.)
| | - Leora I Horwitz
- From the Section of General Internal Medicine, Department of Medicine (M.S.A.-D., K.D., S.I.C.), Section of Cardiovascular Medicine, Department of Internal Medicine (B.H., H.M.K.), and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT; Department of Medicine, Erie County Medical Center, Buffalo, NY (N.P.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K., S.I.C.); Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT (H.M.K.); Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center (L.I.H.); and Division of Healthcare Delivery Science, Department of Population Health and Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine (L.I.H.).
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Reid DB, Parsons SR, Gill SD, Hughes AJ. Discharge communication from inpatient care: an audit of written medical discharge summary procedure against the new National Health Service Standard for clinical handover. AUST HEALTH REV 2015; 39:197-201. [DOI: 10.1071/ah14095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/29/2014] [Indexed: 12/15/2022]
Abstract
Objective To audit written medical discharge summary procedure and practice against Standard Six (clinical handover) of the Australian National Safety and Quality Health Service Standards at a major regional Victorian health service. Methods Department heads were invited to complete a questionnaire about departmental discharge summary practices. Results Twenty-seven (82%) department heads completed the questionnaire. Seven (26%) departments had a documented discharge summary procedure. Fourteen (52%) departments monitored discharge summary completion and 13 (48%) departments monitored the timeliness of completion. Seven (26%) departments informed the patient of the content of the discharge summary and six (22%) departments provided the patient with a copy. Seven (26%) departments provided training for staff members on how to complete discharge summaries. Completing discharge summaries was usually delegated to the medical intern. Conclusions The introduction of the National Service Standards prompted an organisation-wide audit of discharge summary practices against the external criterion. There was substantial variation in the organisation’s practices. The Standards and the current audit results highlight an opportunity for the organisation to enhance and standardise discharge summary practices and improve communication with general practice. What is known about the topic? The Australian National Safety and Quality Health Service Standards (Standard 6) require health service organisations to implement documented systems that support structured and effective clinical handover. Discharge summaries are an important and often the only form of communication during a patient’s transition from hospital to the community. Incomplete, inaccurate and unavailable discharge summaries are common and expose patients to greater health risks. Junior staff members find completing discharge summaries difficult and fail to receive appropriate education or support. There is little published evidence regarding the discharge summary practices of inpatient health services. What does this paper add? The paper demonstrates that there is substantial variation in practice regarding discharge summaries in a large regional health service. Departments have different processes and vary in the degree of attention and quality assurance provided to discharge summaries. Variable organisation procedures make completing discharge summaries more difficult for junior doctors, who regularly move between departments. Variable practice is likely to increase the risk of absent, untimely, incomplete or incorrect communication between acute and community services, thereby reducing the quality of patient care. It is likely that similar findings would be found in other hospitals. What are the implications for practitioners? To be accredited under the National Safety and Quality Health Service Standards, health organisations must ensure that adequate processes are in place for safe and effective clinical handover. Organisations should reduce the practice variability by standardising processes, monitoring compliance with processes, and training and supporting junior doctors.
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Vickery A, Thompson PL. Eight challenges faced by general practitioners caring for patients after an acute coronary syndrome. Med J Aust 2014; 201:S110-4. [PMID: 25390497 DOI: 10.5694/mja14.01250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/24/2014] [Indexed: 11/17/2022]
Abstract
The general practitioner is essential in the management of the patient who has recently been discharged from hospital following an acute coronary syndrome (ACS), particularly as duration of hospital stay is shorter than in previous decades. GPs caring for patients after an ACS face numerous challenges. Often, the first of these is insufficient or delayed documentation from the discharging hospital, although electronic discharge summaries are alleviating this problem. Post-ACS patients often have comorbidities, and GPs play a key role in managing these. Patients taking dual antiplatelet therapy who need surgery, and post-ACS patients with atrial fibrillation, require particular care from GPs. Patients will often approach their GP for advice on the safety of other drugs, such as smoking cessation medication, and phosphodiesterase type 5 inhibitors for erectile dysfunction. For patients complaining of persistent lethargy after an ACS, GPs must consider several differential diagnoses, including depression, hypotension, hypovolaemia, and side effects of β-blockers. GPs play an important ongoing role in ensuring that target cholesterol levels are reached with statin therapy; this includes ensuring long-term adherence. They may also need to advise patients who want to stop statin therapy, usually due to perceived side effects. Many of these challenges can be met with improved and respectful communication between the hospital, the treating cardiologist and the GP. The patient needs to be closely involved in the decision-making process, particularly when balancing the risks of bleeding versus thrombosis.
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Affiliation(s)
- Alistair Vickery
- School of Primary, Aboriginal, and Rural Health Care, University of Western Australia, Perth, WA, Australia.
| | - Peter L Thompson
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
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Crook M, Ajdukovic M, Angley C, Soulsby N, Doecke C, Stupans I, Angley M. Eliciting comprehensive medication histories in the emergency department: the role of the pharmacist. Pharm Pract (Granada) 2014; 5:78-84. [PMID: 25214922 PMCID: PMC4155155 DOI: 10.4321/s1886-36552007000200005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The Australian Pharmaceutical Advisory Committee guidelines call for a detailed medication history to be taken at the first point of admission to hospital. Accurate medication histories are vital in optimising health outcomes and have been shown to reduce mortality rates. This study aimed to examine the accuracy of medication histories taken in the Emergency Department of the Royal Adelaide Hospital. Medication histories recorded by medical staff were compared to those elicited by a pharmacy researcher. The study, conducted over a six-week period, included 100 patients over the age of 70, who took five or more regular medications, had three or more clinical co-morbidities and/or had been discharged from hospital in three months prior to the study. Following patient interviews, the researcher contacted the patient's pharmacist and GP for confirmation and completion of the medication history. Out of the 1152 medications recorded as being used by the 100 patients, discrepancies were found for 966 medications (83.9%). There were 563 (48.9%) complete omissions of medications. The most common discrepancies were incomplete or omitted dosage and frequency information. Discrepancies were mostly medications that treated dermatological and ear, nose and throat disorders but approximately 29% were used to treat cardiovascular disorders. This study provides support for the presence of an Emergency Department pharmacist who can compile a comprehensive and accurate medication history to enhance medication management along the continuum of care. It is recommended that the patient's community pharmacy and GP be contacted for clarification and confirmation of the medication history.
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Affiliation(s)
- Meredith Crook
- School of Pharmacy and Medical Sciences, University of South Australia . Adelaide ( Australia )
| | - Maya Ajdukovic
- School of Pharmacy and Medical Sciences, University of South Australia . Adelaide ( Australia )
| | | | - Natalie Soulsby
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia . Adelaide ( Australia )
| | - Christopher Doecke
- Director of Pharmacy Services, Royal Adelaide Hospital and School of Pharmacy and Medical Sciences, University of South Australia . Adelaide ( Australia )
| | - Ieva Stupans
- Dean Teaching and Learning, Division of Health Sciences, University of South Australia . Adelaide ( Australia )
| | - Manya Angley
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia . Adelaide ( Australia )
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Garrett T, McCormack C. Does an Electronic Discharge Referral System Improve the Quality of Medication Prescribing? JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2014. [DOI: 10.1002/j.2055-2335.2014.tb00013.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tim Garrett
- Central Coast Health Service, Gosford Hospital, Central Coast Local Health District; Gosford NSW
| | - Claire McCormack
- Gosford Hospital, Central Coast Local Health District; Gosford NSW
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Wimsett J, Harper A, Jones P. Review article: Components of a good quality discharge summary: a systematic review. Emerg Med Australas 2014; 26:430-8. [PMID: 25186466 DOI: 10.1111/1742-6723.12285] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present study aims to inform the use of discharge summaries as a marker of the quality of communication between ED and primary care; this systematic review aims to identify a consensus on the key components of a high-quality discharge summary. METHOD A systematic search of the major medical and allied health databases and Google Scholar was conducted, using predetermined criteria for inclusion. Two authors independently reviewed the full texts of potentially relevant studies to determine eligibility for inclusion. Data were extracted using a standard form, and the level of evidence was assessed using a predetermined scale. RESULTS We screened 827 articles, and 84 articles underwent full-text review. Thirty-two studies were included, and 15 studies were level A or B studies. The agreement between authors for level of evidence was good: k = 0.62 (95% confidence interval [CI] 0.4-0.84) and for which components were included was 1011/1056, 95.7% (95% CI 94.3-96.8%). Thirty-four components were identified; however, only four were ranked as important by ≥80% of respondents or scored ≥80% on a scale of importance. These were: discharge diagnosis, treatment received, investigation results and follow-up plan. The quality of information contained in summaries was incompletely assessed in most studies. CONCLUSION The key components to include in a discharge summary are the discharge diagnosis, treatment received, results of investigations and the follow up required. The limited evidence pertaining to ED discharges was consistent with this. The adequacy of the components rather than just their presence or absence should also be considered when assessing the quality of discharge summaries.
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Affiliation(s)
- Jordon Wimsett
- Emergency Department, Wellington Hospital, Wellington, New Zealand
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Maurice AP, Chan S, Pollard CW, Kidd RA, Ayre SJ, Ward HE, Walters DL. Improving the quality of hospital discharge summaries utilising an electronic prompting system. BMJ QUALITY IMPROVEMENT REPORTS 2014; 3:bmjquality_uu200548.w2201. [PMID: 27493731 PMCID: PMC4949611 DOI: 10.1136/bmjquality.u200548.w2201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/22/2014] [Indexed: 11/06/2022]
Abstract
The discharge summary (DS) is a summary of an inpatient admission, patient's health state, and future treatment plans which is delivered to the patient's primary care provider. The DS is often incomplete, inaccurate, or unclear. The aim of this project was to improve the quality of the DS through the use of an electronic prompting system. The electronic prompting system was implemented in the acute medical and surgical wards of the hospital as an adjunct to a pre-existing, widely used hospital program that documents all the patients in a ward or belonging to a particular treating team. When using the program, a doctor enters information (with the assistance of the treating consultant) from a drop-down menu and is prompted to include common, departmental specific diagnoses, co-morbidities, complications, and procedures that were commonly missed or documented incorrectly in the DS. Fifteen DSs were randomly selected from a two month period immediately prior to the intervention period and were rated by an external, experienced general practitioner (GP) using a scoring system consistent with the Australian Medical Association Guidelines for quality DSs. Fifteen random DSs from a two month period, four months post-implementation were also rated by the same GP. The quality of the DS improved in all categories evaluated. The overall quality improved from mean (± SD) 2.86 ± 1.64 to 4.13 ± 0.92 out of 5 (p = 0.031). Additionally the implementation of the system was associated with improvements in documentation of the diagnosis, co-morbidities and other relevant clinical information. In summary, electronic prompting systems can improve the quality of DSs to ensure the information contained within the DS is more accurate and complete.
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Affiliation(s)
| | - Samuel Chan
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | | | - Richard A Kidd
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Stephen J Ayre
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Helen E Ward
- The Prince Charles Hospital, Brisbane, Queensland, Australia
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Díaz CA. Strengthening primary care as main point of entry to the Argentine health system. Medwave 2013. [DOI: 10.5867/medwave.2013.08.5792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Soerensen AL, Lisby M, Nielsen LP, Poulsen BK, Mainz J. The medication process in a psychiatric hospital: are errors a potential threat to patient safety? Risk Manag Healthc Policy 2013; 6:23-31. [PMID: 24049464 PMCID: PMC3775703 DOI: 10.2147/rmhp.s47723] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. METHODS A cross-sectional study using three methods for detecting errors: (1) direct observation; (2) unannounced control visits in the wards collecting dispensed drugs; and (3) chart reviews. All errors, except errors in discharge summaries, were assessed for potential consequences by two clinical pharmacologists. SETTING Three psychiatric wards with adult patients at Aalborg University Hospital, Denmark, from January 2010-April 2010. THE OBSERVATIONAL UNIT The individual handling of medication (prescribing, dispensing, and administering). RESULTS In total, 189 errors were detected in 1,082 opportunities for error (17%) of which 84/998 (8%) were assessed as potentially harmful. The frequency of errors was: prescribing, 10/189 (5%); dispensing, 18/189 (10%); administration, 142/189 (75%); and discharge summaries, 19/189 (10%). The most common errors were omission of pro re nata dosing regime in computerized physician order entry, omission of dose, lack of identity control, and omission of drug. CONCLUSION Errors throughout the medication process are common in psychiatric wards to an extent which resembles error rates in somatic care. Despite a substantial proportion of errors with potential to harm patients, very few errors were considered potentially fatal. Medical staff needs greater awareness of medication safety and guidelines related to the medication process. Many errors in this study might potentially be prevented by nursing staff when handling medication and observing patients for effect and side effects of medication. The nurses' role in psychiatric medication safety should be further explored as nurses appear to be in the unique position to intercept errors before they reach the patient.
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Affiliation(s)
- Ann Lykkegaard Soerensen
- Faculty of Social Sciences and of Health Sciences, Aalborg University, Aalborg, Denmark ; Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
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Horwitz LI, Jenq GY, Brewster UC, Chen C, Kanade S, Van Ness PH, Araujo KLB, Ziaeian B, Moriarty JP, Fogerty RL, Krumholz HM. Comprehensive quality of discharge summaries at an academic medical center. J Hosp Med 2013; 8:436-43. [PMID: 23526813 PMCID: PMC3695055 DOI: 10.1002/jhm.2021] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 01/11/2013] [Accepted: 01/16/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Discharge summaries are essential for safe transitions from hospital to home. OBJECTIVE To conduct a comprehensive quality assessment of discharge summaries. DESIGN Prospective cohort study. SUBJECTS Three hundred seventy-seven patients discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia. MEASURES Discharge summaries were assessed for timeliness of dictation, transmission of the summary to appropriate outpatient clinicians, and presence of key content including elements required by The Joint Commission and elements endorsed by 6 medical societies in the Transitions of Care Consensus Conference (TOCCC). RESULTS A total of 376 of 377 patients had completed discharge summaries. A total of 174 (46.3%) summaries were dictated on the day of discharge; 93 (24.7%) were completed more than a week after discharge. A total of 144 (38.3%) discharge summaries were not sent to any outpatient physician. On average, summaries included 5.6 of 6 The Joint Commission elements and 4.0 of 7 TOCCC elements. Summaries dictated by hospitalists were more likely to be timely and to include key content than summaries dictated by housestaff or advanced practice nurses. Summaries dictated on the day of discharge were more likely to be sent to outside physicians and to include key content. No summary met all 3 quality criteria of timeliness, transmission, and content. CONCLUSIONS Discharge summary quality is inadequate in many domains. This may explain why individual aspects of summary quality such as timeliness or content have not been associated with improved patient outcomes. However, improving discharge summary timeliness may also improve content and transmission.
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Affiliation(s)
- Leora I Horwitz
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA.
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Aebersold M, Tschannen D, Sculli G. Improving Nursing Students’ Communication Skills Using Crew Resource Management Strategies. J Nurs Educ 2013; 52:125-30. [DOI: 10.3928/01484834-20130205-01] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 09/19/2012] [Indexed: 11/20/2022]
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Briggs AM, Lee N, Sim M, Leys TJ, Yates PJ. Hospital discharge information after elective total hip or knee joint replacement surgery: A clinical audit of preferences among general practitioners. Australas Med J 2012; 5:544-50. [PMID: 23173019 DOI: 10.4066/amj.2012.1471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The demand for elective joint replacement (EJR) surgery for degenerative joint disease continues to rise in Australia, and relative to earlier practices, patients are discharged back to the care of their general practitioner (GP) and other community-based providers after a shorter hospital stay and potentially greater post-operative acuity. In order to coordinate safe and effective post-operative care, GPs rely on accurate, timely and clinically-informative information from hospitals when their patients are discharged. The aim of this project was to undertake an audit with GPs regarding their preferences about the components of information provided in discharge summaries for patients undergoing EJR surgery for the hip or knee.GPs in a defined catchment area were invited to respond to an online audit instrument, developed by an interdisciplinary group of clinicians with knowledge of orthopaedic surgery practices. The 15-item instrument required respondents to rank the importance of components of discharge information developed by the clinician working group, using a three-point rating scale.Fifty-three GPs and nine GP registrars responded to the audit invitation (11.0% response rate). All discharge information options were ranked as 'essential' by a proportion of respondents, ranging from 14.8-88.5%. Essential information requested by the respondents included early post-operative actions required by the GP, medications prescribed, post-operative complications encountered and noting of any allergies. Non-essential information related to the prosthesis used. The provision of clinical guidelines was largely rated as 'useful' information (47.5-56.7%).GPs require a range of clinical information to safely and effectively care for their patients after discharge from hospital for EJR surgery. Implementation of changes to processes used to create discharge summaries will require engagement and collaboration between clinical staff, hospital administrators and information technology staff, supported in parallel by education provided to junior medical staff.
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Affiliation(s)
- Andrew M Briggs
- Department of Health, Government of Western Australia ; Curtin Health Innovation Research Institute, Curtin University, Australia
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Fuji KT, Abbott AA, Norris JF. Exploring care transitions from patient, caregiver, and health-care provider perspectives. Clin Nurs Res 2012; 22:258-74. [PMID: 23113935 DOI: 10.1177/1054773812465084] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Care transitions involve coordination of patient care across multiple care settings. Many problems occur during care transitions resulting in negative patient outcomes and unnecessary readmissions. The purpose of this study was to describe the experience of care transitions from patient, caregiver, and health-care provider perspectives in a single metropolitan Midwest city. A qualitative descriptive design was used to solicit patients', caregivers', and health-care providers' perceptions of care transitions, their role within the process, barriers to effective care transitions, and strategies to overcome these barriers. Five themes emerged: preplanned admissions are ideal; lack of needed patient information upon admission; multiple services are needed in preparing patients for discharge; rushed or delayed discharges lead to patient misunderstanding; and difficulties in following aftercare instructions. Findings illustrated provider difficulty in meeting multiple care needs, and the need for patient-centered care to achieve positive outcomes associated with quality measures, reduced readmissions, and care transitions.
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Bondesson A, Eriksson T, Kragh A, Holmdahl L, Midlöv P, Höglund P. In-hospital medication reviews reduce unidentified drug-related problems. Eur J Clin Pharmacol 2012; 69:647-55. [PMID: 22955893 DOI: 10.1007/s00228-012-1368-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine the impact of a new model of care, in which a clinical pharmacist conducts structured medication reviews and a multi-professional team collates systematic medication care plans, on the number of unidentified DRPs in a hospital setting. METHODS In a prospective two-period study, patients admitted to an internal medicine ward at the University Hospital of Lund, Sweden, were included if they were ≥ 65 years old, used ≥ 3 medications on a regular basis and had stayed on the ward for ≥ 5 weekdays. Intervention patients were given the new model of care and control patients received conventional care. DRPs were then retrospectively identified after study completion from blinded patient records for both intervention and control patients. Two pairs of evaluators independently evaluated and classified these DRPs as having been identified/unidentified during the hospital stay and according to type and clinical significance. The primary endpoint was the number of unidentified DRPs, and the secondary endpoints were the numbers of unidentified DRPs within each type and clinical significance category. RESULTS The study included a total of 141 (70 intervention and 71 control) patients. The intervention group benefited from a reduction in the total number of unidentified DRPs per patient during the hospital stay: intervention group median 1 (1st-3rd quartile 0-2), control group 9 (6-13.5) (p < 0.001), and also in the number of medications associated with unidentified DRPs per patient: intervention group 1 (0-2), control group 8 (5-10) (p < 0.001). All sub-categories of DRPs that were frequent in the control group were significantly reduced in the intervention group. Similarly, the DRPs were less clinically significant in the intervention group. CONCLUSIONS A multi-professional team, including a clinical pharmacist, conducting structured medication reviews and collating systematic medication care plans proved very effective in reducing the number of unidentified DRPs for elderly in-patients.
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Affiliation(s)
- Asa Bondesson
- The Department of Medicines Management and Informatics, Region Skåne, Kristianstad, Sweden.
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