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Solbakken LM, Sundseth A, Langhammer B, Brovold T. Are physiotherapists and occupational therapists following the guidelines for discharge summary?-An analysis of the content of physiotherapists' and occupational therapists' discharge summaries and their adherence to stroke guideline recommendations. PLoS One 2024; 19:e0308039. [PMID: 39226253 PMCID: PMC11371198 DOI: 10.1371/journal.pone.0308039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/16/2024] [Indexed: 09/05/2024] Open
Abstract
PURPOSE Discharge summaries are important tools for communication between health care levels and can ensure continuity of rehabilitation. This study aims to gain insight into the content of discharge summaries written by hospital physiotherapists and occupational therapists regarding patients with stroke, and their adherence to recommended criteria for discharge summaries. MATERIAL AND METHODS 31 physiotherapy and multidisciplinary discharge summaries, for stroke patients discharged home from hospital with need of follow-up, were included in the study. We employed qualitative content analysis and descriptive statistics to explore and describe the content. RESULTS The physiotherapists and occupational therapists adhered to the recommended criteria for content in varying degree. The main focus for physiotherapists and occupational therapists were description of ADL, sensorimotor and general cognitive functions, they rarely report tolerance to exercise, and the specific cognitive abilities to follow instruction and learn were often omitted. Less focus was put on patients' experiences and needs during acute stroke, and description of goals were omitted in the physiotherapy discharge summaries. CONCLUSION While the physiotherapists and occupational therapists complement each other in their assessment of patients and inform the reader about both sensorimotor and cognitive functions and abilities, they omit some of the specific criteria for rehabilitation. Despite the omissions, the information provided is specific to the patients' function and needs.
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Affiliation(s)
- Liss Marita Solbakken
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Antje Sundseth
- Department of Neurology, Akershus University Hospital, Nordbyhagen, Lørenskog, Norway
| | - Birgitta Langhammer
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Therese Brovold
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
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Mikkelsen TH, Søndergaard J, Kjær NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Designing a tool ensuring older patients the right medication at the right time after discharge from hospital- the first step in a participatory design process. BMC Health Serv Res 2024; 24:511. [PMID: 38658997 PMCID: PMC11040918 DOI: 10.1186/s12913-024-10992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need. METHODS We conducted a participatory design approach to collect information from patients, relatives, and healthcare professionals. The informants were asked to design their take on a tool ensuring that patients received the correct medication after discharge from the hospital. We included two patients using five or more medications daily, one relative, three general practitioners, four nurses from different healthcare sectors, two hospital physicians, and three pharmacists. RESULTS The patients' solution was a physical location providing a medication overview, including side effects and interactions. Healthcare professionals suggested different solutions, including targeted and timely information that provided an overview of the patient's diagnoses, treatment and medication. The common themes identified across all sub-groups were: (1) Overview of medications, side effects, and diagnoses, (2) Sharing knowledge among healthcare professionals, (3) Timely discharge letters, (4) Does the shared medication record and existing communication platforms provide relevant information to the patient or healthcare professional? CONCLUSION All study participants describe the need for a more concise, relevant overview of information. This study describes elements for further elaboration in future participatory design processes aimed at creating a tool to ensure older patients receive the correct medication at the correct time.
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Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjær
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Lene Juel Kjeldsen
- The hospital pharmacy research unit, Hospital Sønderjylland, Aabenraa, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Sánchez-Rosenberg G, Magnéli M, Barle N, Kontakis MG, Müller AM, Wittauer M, Gordon M, Brodén C. ChatGPT-4 generates orthopedic discharge documents faster than humans maintaining comparable quality: a pilot study of 6 cases. Acta Orthop 2024; 95:152-156. [PMID: 38597205 PMCID: PMC10959013 DOI: 10.2340/17453674.2024.40182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/28/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND AND PURPOSE Large language models like ChatGPT-4 have emerged. They hold the potential to reduce the administrative burden by generating everyday clinical documents, thus allowing the physician to spend more time with the patient. We aimed to assess both the quality and efficiency of discharge documents generated by ChatGPT-4 in comparison with those produced by physicians. PATIENTS AND METHODS To emulate real-world situations, the health records of 6 fictional orthopedic cases were created. Discharge documents for each case were generated by a junior attending orthopedic surgeon and an advanced orthopedic resident. ChatGPT-4 was then prompted to generate the discharge documents using the same health record information. The quality assessment was performed by an expert panel (n = 15) blinded to the source of the documents. As secondary outcome, the time required to generate the documents was compared, logging the duration of the creation of the discharge documents by the physician and by ChatGPT-4. RESULTS Overall, both ChatGPT-4 and physician-generated notes were comparable in quality. Notably, ChatGPT-4 generated discharge documents 10 times faster than the traditional method. 4 events of hallucinations were found in the ChatGPT-4-generated content, compared with 6 events in the human/physician produced notes. CONCLUSION ChatGPT-4 creates orthopedic discharge notes faster than physicians, with comparable quality. This shows it has great potential for making these documents more efficient in orthopedic care. ChatGPT-4 has the potential to significantly reduce the administrative burden on healthcare professionals.
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Affiliation(s)
| | - Martin Magnéli
- Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital, Stockholm; Sweden
| | - Niklas Barle
- Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital, Stockholm; Sweden
| | - Michael G Kontakis
- Department of Surgical Sciences, Orthopedics, Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Marc Müller
- Department of Orthopedic and Trauma Surgery, University Hospital Basel, Switzerland
| | - Matthias Wittauer
- Department of Orthopedic and Trauma Surgery, University Hospital Basel, Switzerland
| | - Max Gordon
- Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital, Stockholm; Sweden
| | - Cyrus Brodén
- Department of Surgical Sciences, Orthopedics, Uppsala University Hospital, Uppsala, Sweden.
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Fazal F, Adil ML, Ijaz T, Ahmad Khan S, Imran Butt A, Abid A, Bashir MN, Ambreen S, Chaudhry TZ, Malik BH. Improving the Quality and Completeness of Discharge Summaries at a Tertiary Care Hospital in Pakistan: A Quality Improvement Project. Cureus 2024; 16:e56134. [PMID: 38487648 PMCID: PMC10938087 DOI: 10.7759/cureus.56134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Discharge summaries (DS) allow continued patient care after being discharged from the hospital. Only a few quality improvement projects (QIPs) focused on assessing and improving the quality and completeness of DS at tertiary care hospitals have been undertaken in Pakistan. This QIP aimed to evaluate and enhance the quality and completeness of DS at a tertiary care hospital in Pakistan to facilitate seamless healthcare transitions. Methods A QIP was conducted in the medical unit of a tertiary care hospital in Rawalpindi, Pakistan. The DS were assessed using the e-discharge summary self-assessment checklist devised by the Royal College of Physicians (RCP). This QIP was done by the plan, do, study, act (PDSA) cycle. The PDSA cycle comprised two audit cycles and an intervention in between them. The first audit cycle (AC) was conducted on 150 DS. Its duration was from March 2023 to June 2023. An educational workshop was conducted before the re-audit cycle (RAC) to address deficiencies and reinforce the implementation of the guidelines provided by the RCP. The RAC was conducted from June 2023 to August 2023. 100 DS were studied and analyzed to assess for improvement in the completeness of DS. Frequencies and percentages were calculated in each audit cycle. The Chi-squared test was applied to compare the statistical difference between the results of both audit cycles. Results A total of 150 DS were analyzed in the first AC and 100 DS in the RAC. The results of the first AC show that the details of any allergies were recorded only in 3% of the DS; this percentage significantly improved to 51% after the RAC (p-value <0.05). Relevant past medical history was included in 52% and 88% of the DS during the first AC and RAC, respectively (p-value <0.05). Secondary diagnoses were written in 54% and 71% of the DS during the first AC and RAC, respectively (p-value <0.05). Details of relevant investigations were included in 60% and 88% of the DS during the first AC and RAC, respectively (p-value <0.05). The post-discharge management plan was written in 90% and 98% of the DS during the first AC and RAC, respectively (p-value <0.05). The follow-up plan was written clearly in 65% and 93% of the DS during the first AC and RAC, respectively (p-value <0.05). Conclusion The DS was found to be incomplete after analyzing the results of the first AC. The details related to allergies, medications, operations, and procedures were found to be missing in the majority of the cases. No mention of the patient's concerns or expectations was made in the DS. The results of the RAC showed improvement in the level of completeness of DS. The majority of the weak points observed after the first AC seemed to have improved after the RAC, which shows that intervention proved to be quite effective in improving the completeness and quality of DS. The RAC showed significant improvement in the completeness of the details relating to investigations, allergies, past medical history, secondary diagnoses, and the post-discharge follow-up plan. QIP must be routinely carried out to assess and improve the completeness and quality of DS at hospitals.
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Affiliation(s)
- Faizan Fazal
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Maham L Adil
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Talha Ijaz
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | | | | | - Areesha Abid
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Muhammad N Bashir
- Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Saima Ambreen
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Taha Z Chaudhry
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Bilal H Malik
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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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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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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Biringer E, Helgeland J, Hellesen HB, Aβmus J, Hartveit M. Development and testing of the QDis-MH checklist for discharge letters from specialised mental healthcare: a stakeholder-centred study. BMJ Open Qual 2023; 12:bmjoq-2022-002036. [PMID: 37019467 PMCID: PMC10083855 DOI: 10.1136/bmjoq-2022-002036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The 'discharge letter' is the mandatory written report sent from specialists in the specialist services to general practitioners (GPs) on patient discharge. Clear recommendations from relevant stakeholders for contents of discharge letters and instruments to measure the quality of discharge letters in mental healthcare are needed. The objectives were to (1) detect which information relevant stakeholders defined as important to include in discharge letters from mental health specialist services, (2) develop a checklist to measure the quality of discharge letters and (3) test the psychometric properties of the checklist. METHODS We used a stepwise multimethod stakeholder-centred approach. Group interviews with GPs, mental health specialists and patient representatives defined 68 information items with 10 consensus-based thematic headings relevant to include in high-quality discharge letters. Information items rated as highly important by GPs (n=50) were included in the Quality of Discharge information-Mental Health (QDis-MH) checklist. The 26-item checklist was tested by GPs (n=18) and experts in healthcare improvement or health services research (n=15). Psychometric properties were assessed using estimates of intrascale consistency and linear mixed effects models. Inter-rater and test-retest reliability were assessed using Gwet's agreement coefficient (Gwet's AC1) and intraclass correlation coefficients. RESULTS The QDis-MH checklist had satisfactory intrascale consistency. Inter-rater reliability was poor to moderate, and test-retest reliability was moderate. In descriptive analyses, mean checklist scores were higher in the category of discharge letters defined as 'good' than in 'medium' or 'poor' letters, but differences did not reach statistical significance. CONCLUSIONS GPs, mental health specialists and patient representatives defined 26 information items relevant to include in discharge letters in mental healthcare. The QDis-MH checklist is valid and feasible. However, when using the checklist, raters should be trained and the number of raters kept to a minimum due to questionable inter-rater reliability.
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Affiliation(s)
- Eva Biringer
- Department of Research and Innovation, Helse Fonna HF, Haugesund/Valen/Stord, Norway
| | | | | | - Jörg Aβmus
- Centre for Clinical Research, Helse Bergen HF, Bergen, Norway
| | - M Hartveit
- Department of Research and Innovation, Helse Fonna HF, Haugesund/Valen/Stord, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Shahid A, Sept B, Kupsch S, Brundin-Mather R, Piskulic D, Soo A, Grant C, Leigh JP, Fiest KM, Stelfox HT. Development and pilot implementation of a patient-oriented discharge summary for critically Ill patients. World J Crit Care Med 2022; 11:255-268. [PMID: 36051938 PMCID: PMC9305680 DOI: 10.5492/wjccm.v11.i4.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 06/18/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients leaving the intensive care unit (ICU) often experience gaps in care due to deficiencies in discharge communication, leaving them vulnerable to increased stress, adverse events, readmission to ICU, and death. To facilitate discharge communication, written summaries have been implemented to provide patients and their families with information on medications, activity and diet restrictions, follow-up appointments, symptoms to expect, and who to call if there are questions. While written discharge summaries for patients and their families are utilized frequently in surgical, rehabilitation, and pediatric settings, few have been utilized in ICU settings. AIM To develop an ICU specific patient-oriented discharge summary tool (PODS-ICU), and pilot test the tool to determine acceptability and feasibility. METHODS Patient-partners (i.e., individuals with lived experience as an ICU patient or family member of an ICU patient), ICU clinicians (i.e., physicians, nurses), and researchers met to discuss ICU patients' specific informational needs and design the PODS-ICU through several cycles of discussion and iterative revisions. Research team nurses piloted the PODS-ICU with patient and family participants in two ICUs in Calgary, Canada. Follow-up surveys on the PODS-ICU and its impact on discharge were administered to patients, family participants, and ICU nurses. RESULTS Most participants felt that their discharge from the ICU was good or better (n = 13; 87.0%), and some (n = 9; 60.0%) participants reported a good understanding of why the patient was in ICU. Most participants (n = 12; 80.0%) reported that they understood ICU events and impacts on the patient's health. While many patients and family participants indicated the PODS-ICU was informative and useful, ICU nurses reported that the PODS-ICU was "not reasonable" in their daily clinical workflow due to "time constraint". CONCLUSION The PODS-ICU tool provides patients and their families with essential information as they discharge from the ICU. This tool has the potential to engage and empower patients and their families in ensuring continuity of care beyond ICU discharge. However, the PODS-ICU requires pairing with earlier discharge practices and integration with electronic clinical information systems to fit better into the clinical workflow for ICU nurses. Further refinement and testing of the PODS-ICU tool in diverse critical care settings is needed to better assess its feasibility and its effects on patient health outcomes.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Danijela Piskulic
- Department of Psychiatry, Hotchkiss Brain Institute, Calgary T2N 4Z6, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Christopher Grant
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
- School of Health Administration, Dalhousie University, Halifax B3H 4R2, Nova Scotia, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
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Jeffries M, Keers RN, Belither H, Sanders C, Gallacher K, Alqenae F, Ashcroft DM. Understanding the implementation, impact and sustainable use of an electronic pharmacy referral service at hospital discharge: A qualitative evaluation from a sociotechnical perspective. PLoS One 2021; 16:e0261153. [PMID: 34936661 PMCID: PMC8694480 DOI: 10.1371/journal.pone.0261153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/28/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The transition of patients across care settings is associated with a high risk of errors and preventable medication-related harm. Ensuring effective communication of information between health professionals is considered important for improving patient safety. A National Health Service(NHS) organisation in the North West of England introduced an electronic transfer of care around medicines (TCAM) system which enabled hospital pharmacists to send information about patient’s medications to their nominated community pharmacy. We aimed to understand the adoption, and the implications for sustainable use in practice of the TCAM service Methods We evaluated the TCAM service in a Clinical Commissioning Group (CCG) and NHS Foundation Trust in Salford, United Kingdom (UK). Participants were opportunistically recruited to take part in qualitative interviews through stakeholder networks and during hospital admission, and included hospital pharmacists, hospital pharmacy technicians, community pharmacists, general practice-based pharmacists, patients and their carers. A thematic analysis, that was iterative and concurrent with data collection, was undertaken using a template approach. The interpretation of the data was informed by broad sociotechnical theory. Results Twenty-three interviews were conducted with health care professionals patients and carers. The ways in which the newly implemented TCAM intervention was adopted and used in practice and the perceptions of it from different stakeholders were conceptualised into four main thematic areas: The nature of the network and how it contributed to implementation, use and sustainability; The material properties of the system; How work practices for medicines safety were adapted and evolved; and The enhancement of medication safety activities. The TCAM intervention was perceived as effective in providing community pharmacists with timely, more accurate and enhanced information upon discharge. This allowed for pharmacists to enhance clinical services designed to ensure that accurate medication reconciliation was completed, and the correct medication was dispensed for the patient. Conclusions By providing pharmacy teams with accurate and enhanced information the TCAM intervention supported healthcare professionals to establish and/or strengthen interprofessional networks in order to provide clinical services designed to ensure that accurate medication reconciliation and dispensing activities were completed. However, the intervention was implemented into a complex and at times fragmented network, and we recommend opportunities be explored to fully integrate this network to involve patients/carers, general practice pharmacists and two-way communication between primary and secondary care to further enhance the reach and impact of the TCAM service.
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Affiliation(s)
- Mark Jeffries
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- * E-mail:
| | - Richard N. Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Pharmacy Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Division of Population Health, Health Services Research & Primary Care University of Manchester, Manchester, United Kingdom
| | - Kay Gallacher
- Patient and Public Involvement, NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Fatema Alqenae
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
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How can communication to GPs at hospital discharge be improved? A systems approach. BJGP Open 2021; 6:BJGPO.2021.0148. [PMID: 34620598 PMCID: PMC8958742 DOI: 10.3399/bjgpo.2021.0148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/05/2022] Open
Abstract
Background Poor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries that are commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue’s resistance to decades of improvement work. Aim To understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement. Design & setting A qualitative exploration of the secondary-to-primary care communication system surrounding a large UK hospital. Method A systems approach, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n = 18) of clinical and administrative staff from both sides of the primary–secondary care interface, and a subsequent focus group. Results The largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates. Conclusion Facilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance such as patient complexity.
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11
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de Sordi D, Kappen S, Otto-Sobotka F, Kulschewski A, Weyland A, Gutierrez L, Fortuny J, Reinold J, Schink T, Timmer A. Validity of hospital ICD-10-GM codes to identify anaphylaxis. Pharmacoepidemiol Drug Saf 2021; 30:1643-1652. [PMID: 34418227 DOI: 10.1002/pds.5348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE Anaphylaxis (ANA) is an important adverse drug reaction. We examined positive predictive values (PPV) and other test characteristics of ICD-10-GM code algorithms for detecting ANA as used in a multinational safety study (PASS). METHODS We performed a cross-sectional study on routine data from a German academic hospital (2004-2019, age ≥ 18). Chart review was used for case verification. Potential cases were identified from the hospital administration system. The main outcome required at least one of the following: any type of specific in-hospital code (T78.2, T88.6, and T80.5) OR specific outpatient code in combination with a symptom code OR in-hospital non-specific code (T78.4, T88.7, and Y57.9) in combination with two symptom codes. PPV were calculated with 95% confidence interval. Sensitivity analyses modified type of codes, unit of analysis, verification criteria and time period. The most specific algorithm used only primary codes for ANA (numbers added in brackets). RESULTS Four hundred and sixteen eligible cases were evaluated, and 78 (37) potential ANA cases were identified. PPV were 62.8% (95% CI 51.1-73.5) (main) and 77.4% (58.9-90.4) (most specific). PPV from all modifications ranged from 12.9% to 80.6%. The sensitivity of the main algorithm was 66.2%, specificity 91.5%, and negative predictive value 92.6%. Corresponding figures for the most specific algorithm were 32.4%, 98.0%, and 87.0%. CONCLUSIONS The PPV of the main algorithm seems of acceptable validity for use in comparative safety research but will underestimate absolute risks by about a third. Restriction to primary discharge codes markedly improves PPV to the expense of reducing sensitivity.
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Affiliation(s)
- Dominik de Sordi
- Division of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Sanny Kappen
- Division of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Fabian Otto-Sobotka
- Division of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Anke Kulschewski
- Section for Kidney Disease and Hypertension, Clinic of Internal Medicine, Klinikum Oldenburg, Oldenburg, Germany
| | - Andreas Weyland
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Therapy, Klinikum Oldenburg, Oldenburg, Germany
| | - Lia Gutierrez
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Joan Fortuny
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Jonas Reinold
- Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tania Schink
- Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Antje Timmer
- Division of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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12
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Nicol E, Hanmer LA, Mukumbang FC, Basera W, Zitho A, Bradshaw D. Is the routine health information system ready to support the planned national health insurance scheme in South Africa? Health Policy Plan 2021; 36:639-650. [PMID: 33822055 PMCID: PMC8173599 DOI: 10.1093/heapol/czab008] [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] [Accepted: 01/08/2021] [Indexed: 11/03/2022] Open
Abstract
Implementation of a National Health Insurance (NHI) in South Africa requires a reliable, standardized health information system that supports Diagnosis-Related Groupers for reimbursements and resource management. We assessed the quality of inpatient health records, the availability of standard discharge summaries and coded clinical data and the congruence between inpatient health records and discharge summaries in public-sector hospitals to support the NHI implementation in terms of reimbursement and resource management. We undertook a cross-sectional health-records review from 45 representative public hospitals consisting of seven tertiary, 10 regional and 28 district hospitals in 10 NHI pilot districts representing all nine provinces. Data were abstracted from a randomly selected sample of 5795 inpatient health records from the surgical, medical, obstetrics and gynaecology, paediatrics and psychiatry departments. Quality was assessed for 10 pre-defined data elements relevant to NHI reimbursements, by comparing information in source registers, patient folders and discharge summaries for patients admitted in March and July 2015. Cohen's/Fleiss' kappa coefficients (κ) were used to measure agreements between the sources. While 3768 (65%) of the 5795 inpatient-level records contained a discharge summary, less than 835 (15%) of diagnoses were coded using ICD-10 codes. Despite most of the records having correct patient identifiers [κ: 0.92; 95% confidence interval (CI) 0.91-0.93], significant inconsistencies were observed between the registers, patient folders and discharge summaries for some data elements: attending physician's signature (κ: 0.71; 95% CI 0.67-0.75); results of the investigation (κ: 0.71; 95% CI 0.69-0.74); patient's age (κ: 0.72; 95% CI 0.70-0.74); and discharge diagnosis (κ: 0.92; 95% CI 0.90-0.94). The strength of agreement for all elements was statistically significant (P-value ≤ 0.001). The absence of coded inpatient diagnoses and identified data inaccuracies indicates that existing routine health information systems in public-sector hospitals in the NHI pilot districts are not yet able to sufficiently support reimbursements and resource management. Institutional capacity is needed to undertake diagnostic coding, improve data quality and ensure that a standard discharge summary is completed for every inpatient.
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Affiliation(s)
- Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council. South Africa.,Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Lyn A Hanmer
- Burden of Disease Research Unit, South African Medical Research Council. South Africa
| | - Ferdinand C Mukumbang
- Burden of Disease Research Unit, South African Medical Research Council. South Africa.,School of Public Health, University of the Western Cape
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council. South Africa.,School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Andiswa Zitho
- Burden of Disease Research Unit, South African Medical Research Council. South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council. South Africa.,School of Public Health and Family Medicine, University of Cape Town, South Africa
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13
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Ge J, Davis A, Jain A. A retrospective analysis of discharge summaries from a tertiary care hospital medical oncology unit: To assess compliance with documentation of recommended discharge summary components. Cancer Rep (Hoboken) 2021; 5:e1457. [PMID: 34152093 PMCID: PMC8842693 DOI: 10.1002/cnr2.1457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Discharge summaries are essential for health transition between inpatient hospital teams and outpatient general practices. The patient's outcome is dependent on the quality and timeliness of discharge summaries. Aim A retrospective analysis was carried out to assess the compliance with recommended documentation of 697 electronic discharge summaries (eDSs) of oncology inpatients discharged in 2018 from the Canberra Hospital according to the National Guidelines of On‐Screen Presentation of Discharge Summaries. Methods and results Individual medical records were identified and screened for the recommended eDS components according to the National Guidelines. Out of the 17 recommended components, nine components were included in all discharge summaries, two components in more than 99% and two components in 95–96% of discharge summaries. The most frequently omitted components include “information provided to the patient,” “ceased medicine” and “procedures,” and these were omitted in 8, 38 and 82% of discharge summaries, respectively. Conclusion Overall, most discharge summaries adhered to the national guidelines quite well by including most of the recommended components. However, the discharge summary quality is still inadequate in some domains.
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Affiliation(s)
- Jingwei Ge
- ANU Medical School, Australian National University, Canberra, Australia
| | - Alison Davis
- ANU Medical School, Australian National University, Canberra, Australia.,Department of Medical Oncology, the Canberra Hospital, Garran, Australia
| | - Ankit Jain
- ANU Medical School, Australian National University, Canberra, Australia.,Department of Medical Oncology, the Canberra Hospital, Garran, Australia
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14
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Tremoulet PD, Shah PD, Acosta AA, Grant CW, Kurtz JT, Mounas P, Kirchhoff M, Wade E. Usability of Electronic Health Record-Generated Discharge Summaries: Heuristic Evaluation. J Med Internet Res 2021; 23:e25657. [PMID: 33856353 PMCID: PMC8085750 DOI: 10.2196/25657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/11/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. OBJECTIVE This study aimed to (1) identify the information about elderly patients' recent acute care visits needed to coordinate their care, (2) use this information to assess discharge summaries, and (3) provide recommendations to help improve the quality of electronic health record (EHR)-generated discharge summaries, thereby increasing patient safety. METHODS A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently discharged elderly patients. Based upon those data, 2 guidelines for creating useful discharge summaries were created. The new guidelines, along with 17 previously developed medical documentation usability heuristics, were applied to assess 4 simulated elderly patient discharge summaries. RESULTS The initial research effort yielded a list of 29 items that should always be included in elderly patient discharge summaries and a list of 7 "helpful, but not always necessary" items. Evaluation of 4 deidentified elderly patient discharge summaries revealed that none of the documents contained all 36 necessary items; between 14 and 18 were missing. The documents each had several other issues, and they differed significantly in organization, layout, and formatting. CONCLUSIONS Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care transition-related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization.
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Affiliation(s)
- Patrice D Tremoulet
- Department of Psychology, Rowan University, Glassboro, NJ, United States.,Device Evaluation, ECRI, Plymouth Meeting, PA, United States
| | - Priyanka D Shah
- Device Evaluation, ECRI, Plymouth Meeting, PA, United States
| | - Alisha A Acosta
- Department of Biochemistry, Rowan University, Glassboro, NJ, United States
| | - Christian W Grant
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Jon T Kurtz
- Department of Computer Science, Rowan University, Glassboro, NJ, United States
| | - Peter Mounas
- Department of Biological Sciences, Rowan University, Glassboro, NJ, United States
| | - Michael Kirchhoff
- Department of Emergency Medicine, Cooper Medical School, Rowan University, Camden, NJ, United States
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15
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Chodosh J, Goldfeld K, Weinstein BE, Radcliffe K, Burlingame M, Dickson V, Grudzen C, Sherman S, Smilowitz J, Blustein J. The HEAR-VA Pilot Study: Hearing Assistance Provided to Older Adults in the Emergency Department. J Am Geriatr Soc 2021; 69:1071-1078. [PMID: 33576037 DOI: 10.1111/jgs.17037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Poor communication is a barrier to care for people with hearing loss. We assessed the feasibility and potential benefit of providing a simple hearing assistance device during an emergency department (ED) visit, for people who reported difficulty hearing. DESIGN Randomized controlled pilot study. SETTING The ED of New York Harbor Manhattan Veterans Administration Medical Center. PARTICIPANTS One hundred and thirty-three Veterans aged 60 and older, presenting to the ED, likely to be discharged to home, who either (1) said that they had difficulty hearing, or (2) scored 10 or greater (range 0-40) on the Hearing Handicap Inventory-Survey (HHI-S). INTERVENTION Subjects were randomized (1:1), and intervention subjects received a personal amplifier (PA; Williams Sound Pocketalker 2.0) for use during their ED visit. MEASUREMENTS Three survey instruments: (1) six-item Hearing and Understanding Questionnaire (HUQ); (2) three-item Care Transitions Measure; and (3) three-item Patient Understanding of Discharge Information. Post-ED visit phone calls to assess ED returns. RESULTS Of the 133 subjects, 98.3% were male; mean age was 76.4 years (standard deviation (SD) = 9.2). Mean HHI-S score was 19.2 (SD = 8.3). Across all HUQ items, intervention subjects reported better in-ED experience than controls. Seventy-five percent of intervention subjects agreed or strongly agreed that ability to understand what was said was without effort versus 56% for controls. Seventy-five percent of intervention subjects versus 36% of controls said clinicians provided them with an explanation about presenting problems. Three percent of intervention subjects had an ED revisit within 3 days compared with 9.0% controls. CONCLUSION Veterans with hearing difficulties reported improved in-ED experiences with use of PAs, and were less likely to return to the ED within 3 days. PAs may be an important adjunct to older patient ED care but require validation in a larger more definitive randomized controlled trial.
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Affiliation(s)
- Joshua Chodosh
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Keith Goldfeld
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Barbara E Weinstein
- Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Audiology Program, Graduate Center, City University of New York, New York, New York, USA
| | - Kate Radcliffe
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Victoria Dickson
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Corita Grudzen
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.,Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Scott Sherman
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jessica Smilowitz
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Jan Blustein
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.,Robert F. Wagner Graduate School of Public Service, New York University, New York, New York, USA
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16
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Troude P, Nieto I, Brion A, Goudinoux R, Laganier J, Ducasse V, Nizard R, Martinez F, Segouin C. Assessing the impact of a quality improvement program on the quality and timeliness of discharge documents: A before and after study. Medicine (Baltimore) 2020; 99:e23776. [PMID: 33371146 PMCID: PMC7748348 DOI: 10.1097/md.0000000000023776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
Whereas handover of pertinent information between hospital and primary care is necessary to ensure continuity of care and patient safety, both quality of content and timeliness of discharge summary need to be improved. This study aims to assess the impact of a quality improvement program on the quality and timeliness of the discharge summary/letter (DS/DL) in a University hospital with approximatively 40 clinical units using an Electronic medical record (EMR).A discharge documents (DD) quality improvement program including revision of the EMR, educational program, audit (using scoring of DD) and feedback with a ranking of clinical units, was conducted in our hospital between October 2016 and November 2018. Main outcome measures were the proportion of the DD given to the patient at discharge and the mean of the national score assessing the quality of the discharge documents (QDD score) with 95% confidence interval.Intermediate evaluation (2017) showed a significant improvement as the proportion of DD given to patients increased from 63% to 85% (P < .001) and mean QDD score rose from 41 (95%CI [36-46]) to 74/100 (95%CI [71-77]). In the final evaluation (2018), the proportion of DD given to the patient has reached 95% and the mean QDD score was 82/100 (95% CI [80-85]). The areas of the data for admission and discharge treatments remained the lowest level of compliance (44%).The involvement of doctors in the program and the challenge of participating units have fostered the improvement in the quality of the DD. However, the level of appropriation varied widely among clinical units and completeness of important information, such as discharge medications, remains in need of improvement.
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Affiliation(s)
| | | | - Annie Brion
- Direction des Usagers, du Système d’Information et de la Qualité
| | | | | | | | - Rémy Nizard
- Service de chirurgie orthopédique, HU Saint-Louis – Lariboisière – Fernand Widal, AP-HP, Paris, France
| | - Fabien Martinez
- Direction des Usagers, du Système d’Information et de la Qualité
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17
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Mahajan M, Hogewoning JA, Zewald JJA, Kerkmeer M, Feitsma M, van Rijssel DA. The impact of teach-back on patient recall and understanding of discharge information in the emergency department: the Emergency Teach-Back (EM-TeBa) study. Int J Emerg Med 2020; 13:49. [PMID: 32972361 PMCID: PMC7513274 DOI: 10.1186/s12245-020-00306-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/09/2020] [Indexed: 11/21/2022] Open
Abstract
Background Previous research has demonstrated that patients leaving the emergency department (ED) have poor recall and understanding of their discharge information. The teach-back method is an easy technique that can be used to check, and if necessary correct, inaccurate recall. In our study, we aimed to determine the direct and short-term impact of teach-back as well as feasibility for routine use in the ED. Methods A prospective cohort study in an urban, non-academic ED was performed which included adult patients who were discharged from the ED with a new medical problem. The control group with the standard discharge was compared to the intervention group using the teach-back method. Recall and comprehension scores were assessed immediately after discharge and 2–4 days afterward by phone, using four standardized questions concerning their diagnosis, treatment, follow-up care, and return precautions. Results Four hundred eighty-three patients were included in the study, 239 in the control group, and 244 in the intervention group. Patients receiving teach-back had higher scores on all domains immediately after discharge and on three domains after 2–4 days (6.3% versus 4.5%). After teach-back, the proportion of patients that left the ED with a comprehension deficit declined from 49 to 11.9%. Deficits were most common for return precautions in both groups (41.3% versus 8.1%). Teach-back conversation took 1:39 min, versus an average of 3:11 min for a regular discharge interview. Conclusion Teach-back is an efficient and non-time-consuming method to improve patients’ immediate and short-term recall and comprehension of discharge information in the ED.
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Affiliation(s)
- Mandhkani Mahajan
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands.
| | - Janine Alida Hogewoning
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | | | - Margreet Kerkmeer
- Science Department, Reinier de Graaf Hospital, Reinier Academy, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Mathilde Feitsma
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Daphne Annika van Rijssel
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands
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18
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Weetman K, Dale J, Spencer R, Scott E, Schnurr S. GP perspectives on hospital discharge letters: an interview and focus group study. BJGP Open 2020; 4:bjgpopen20X101031. [PMID: 32398346 PMCID: PMC7330207 DOI: 10.3399/bjgpopen20x101031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Written discharge communication following inpatient or outpatient clinic discharge is essential for communicating information to the GP, but GPs' opinions on discharge communication are seldom sought. Patients are sometimes copied into this communication, but the reasons for this variation, and the resultant effects, remain unclear. AIM To explore GP perspectives on how discharge letters can be improved in order to enhance patient outcomes. DESIGN & SETTING The study used narrative interviews with 26 GPs from 13 GP practices within the West Midlands, England. METHOD Interviews were transcribed and data were analysed using corpus linguistics (CL) techniques. RESULTS Elements pivotal to a successful letter were: diagnosis, appropriate follow-up plan, medication changes and reasons, clinical summary, investigations and/or procedures and outcomes, and what information has been given to the patient. GPs supported patients receiving discharge letters and expounded a number of benefits of this practice; for example, increased patient autonomy. Nevertheless, GPs felt that if patients are to receive direct discharge letter copies, modifications such as use of lay language and avoidance of acronyms may be required to increase patient understanding. CONCLUSION GPs reported that discharge letters frequently lacked content items they assessed to be important; GPs highlighted that this can have subsequent ramifications on resources and patient experiences. Templates should be devised that put discharge letter elements assessed to be important by GPs to the forefront. Future research needs to consider other perspectives on letter content, particularly those of patients.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
| | - Jeremy Dale
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
| | - Rachel Spencer
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
| | - Emma Scott
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
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19
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Weetman K, Dale J, Scott E, Schnurr S. The Discharge Communication Study: research protocol for a mixed methods study to investigate and triangulate discharge communication experiences of patients, GPs, and hospital professionals, alongside a corresponding discharge letter sample. BMC Health Serv Res 2019; 19:825. [PMID: 31711500 PMCID: PMC6849198 DOI: 10.1186/s12913-019-4612-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Discharge letters are crucial during care transitions from hospital to home. Research indicates a need for improvement to increase quality of care and decrease adverse outcomes. These letters are often sent from the hospital discharging physician to the referring clinician, typically the patient's General Practitioner (GP) in the UK, and patients may or may not be copied into them. Relatively little is known about the barriers and enablers to sending patients discharge letters. Hence, the aim of this study was to investigate from GP, hospital professional (HP) and patient perspectives how to improve processes of patients receiving letters and increase quality of discharge letters. The study has a particular focus on the impacts of receiving or not receiving letters on patient experiences and quality of care. METHODS The setting was a region in the West Midlands of England, UK. The research aimed to recruit a minimum of 30 GPs, 30 patients and 30 HPs in order to capture 90 experiences of discharge communication. Participating GPs initially screened and selected a range of recent discharge letters which they assessed to be successful and unsuccessful exemplars. These letters identified potential participants who were invited to take part: the HP letter writer, GP recipient and patient. Participant viewpoints are collected through interviews, focus groups and surveys and will be "matched" to the discharge letter sample, so forming multiple-perspective "quartet" cases. These "quartets" allow direct comparisons between different discharge experiences within the same communicative event. The methods for analysis draw on techniques from the fields of Applied Linguistics and Health Sciences, including: corpus linguistics; inferential statistics; content analysis. DISCUSSION This mixed-methods study is novel in attempting to triangulate views of patients, GPs and HPs in relation to specific discharge letters. Patient and practitioner involvement will inform design decisions and interpretation of findings. Recommendations for improving discharge letters and the process of patients receiving letters will be made, with the intention of informing guidelines on discharge communication. Ethics approval was granted in July 2017 by the UK Health Research Authority. Findings will be disseminated in peer-reviewed journals, reports and newsletters, and presentations.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Emma Scott
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Stephanie Schnurr
- Centre for Applied Linguistics, University of Warwick, Coventry, CV4 7AL UK
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20
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Weetman K, Wong G, Scott E, MacKenzie E, Schnurr S, Dale J. Improving best practice for patients receiving hospital discharge letters: a realist review. BMJ Open 2019; 9:e027588. [PMID: 31182447 PMCID: PMC6561435 DOI: 10.1136/bmjopen-2018-027588] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/25/2019] [Accepted: 05/15/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To understand how different outcomes are achieved from adult patients receiving hospital discharge letters from inpatient and outpatient settings. DESIGN Realist review conducted in six main steps: (1) development of initial theory, (2) searching, (3) screening and selection, (4) data extraction and analysis, (5) data synthesis and (6) programme theory (PT) refinement. ELIGIBILITY CRITERIA Documents reporting evidence that met criteria for relevance to the PT. Documents relating solely to mental health or children aged <18 years were excluded. ANALYSIS Data were extracted and analysed using a realist logic of analysis. Texts were coded for concepts relating to context, mechanism, outcome configurations (CMOCs) for the intervention of patients receiving discharge letters. All outcomes were considered. Based on evidence and our judgement, CMOCs were labelled 'positive' or 'negative' in order to clearly distinguish between contexts where the intervention does and does not work. RESULTS 3113 documents were screened and 103 were included. Stakeholders contributed to refining the PT in step 6. The final PT included 48 CMOCs for how outcomes are affected by patients receiving discharge letters. 'Patient choice' emerged as a key influencer to the success (or not) of the intervention. Important contexts were identified for both 'positive' CMOCs (eg, no new information in letter) and 'negative' CMOCs (eg, letter sent without verifying patient contact details). Two key findings were that patient understanding is possibly greater than clinicians perceive, and that patients tend to express strong preference for receiving letters. Clinician concerns emerged as a barrier to wider sharing of discharge letters with patients, which may need to be addressed through organisational policies and direction. CONCLUSIONS This review forms a starting point for explaining outcomes associated with whether or not patients receive discharge letters. It suggests several ways in which current processes might be modified to support improved practice and patient experience.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Emma Scott
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
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21
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Schwarz CM, Hoffmann M, Schwarz P, Kamolz LP, Brunner G, Sendlhofer G. A systematic literature review and narrative synthesis on the risks of medical discharge letters for patients' safety. BMC Health Serv Res 2019; 19:158. [PMID: 30866908 PMCID: PMC6417275 DOI: 10.1186/s12913-019-3989-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background The medical discharge letter is an important communication tool between hospitals and other healthcare providers. Despite its high status, it often does not meet the desired requirements in everyday clinical practice. Occurring risks create barriers for patients and doctors. This present review summarizes risks of the medical discharge letter. Methods The research question was answered with a systematic literature research and results were summarized narratively. A literature search in the databases PubMed and Cochrane Library for Studies between January 2008 and May 2018 was performed. Two authors reviewed the full texts of potentially relevant studies to determine eligibility for inclusion. Literature on possible risks associated with the medical discharge letter was discussed. Results In total, 29 studies were included in this review. The major identified risk factors are the delayed sending of the discharge letter to doctors for further treatments, unintelligible (not patient-centered) medical discharge letters, low quality of the discharge letter, and lack of information as well as absence of training in writing medical discharge letters during medical education. Conclusions Multiple risks factors are associated with the medical discharge letter. There is a need for further research to improve the quality of the medical discharge letter to minimize risks and increase patients’ safety.
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Affiliation(s)
- Christine Maria Schwarz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Magdalena Hoffmann
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria. .,Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1/3, 8036, Graz, Austria.
| | - Petra Schwarz
- Carinthia University of Applied Science, Feldkirchen, Austria
| | - Lars-Peter Kamolz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1/3, 8036, Graz, Austria
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22
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Tsopra R, Wyatt JC, Beirne P, Rodger K, Callister M, Ghosh D, Clifton IJ, Whitaker P, Peckham D. Level of accuracy of diagnoses recorded in discharge summaries: A cohort study in three respiratory wards. J Eval Clin Pract 2019; 25:36-43. [PMID: 30105889 DOI: 10.1111/jep.13020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 11/29/2022]
Abstract
RATIONALE One of the key functions of the discharge summary is to convey accurate diagnostic description of patients. Inaccurate or missing diagnoses may result in a false clinical picture, inappropriate management, poor quality of care, and a higher risk of re-admission. While several studies have investigated the presence or absence of diagnoses within discharge summaries, there are very few published studies assessing the accuracy of these diagnoses. The aim of this study was to measure the accuracy of diagnoses recorded in sample summaries, and to determine if it was correlated with the type of diagnoses (eg, "respiratory" diagnoses), the number of diagnoses, or the length of patient stay. METHODS A prospective cohort study was conducted in three respiratory wards in a large UK NHS Teaching Hospital. We determined the reference list of diagnoses (the closest to the true state of the patient based on consultant knowledge, patient records, and laboratory investigations) for comparison with the diagnoses recorded in a discharge summary. To enable objective comparison, all patient diagnoses were encoded using a standardized terminology (ICD-10). Inaccuracy of the primary diagnosis alone and all diagnoses in discharge summaries was measured and then correlated with type of diseases, number of diagnoses, and length of patient stay. RESULTS A total of 107 of 110 consecutive discharge summaries were analysed. The mean inaccuracy rate per discharge summary was 55% [95% CI 52 to 58%]. Primary diagnoses were wrong, inaccurate, missing, or mis-recorded as a secondary diagnosis in half the summaries. The inaccuracy rate was correlated with the type of disease but not with number of diagnoses nor length of patient stay. CONCLUSION Our study showed that diagnoses were not accurately recorded in discharge summaries, highlighting the need to measure and improve discharge summary quality.
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Affiliation(s)
- Rosy Tsopra
- Leeds Centre for Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom.,Leeds Institute of Health Sciences, 101, Clarendon Rd, Leeds LS2 9LJ, United Kingdom.,Université Paris 13, Bobigny, France.,AP-HP, Paris, France
| | - Jeremy C Wyatt
- Wessex Institute of Health and Research, Faculty of Medicine, University of Southampton, SO16 7NS, United Kingdom
| | - Paul Beirne
- Leeds Centre for Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom
| | - Kirsty Rodger
- Leeds Centre for Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom
| | - Matthew Callister
- Leeds Centre for Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom
| | - Dipansu Ghosh
- Leeds Centre for Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom
| | - Ian J Clifton
- Leeds Centre for Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom
| | - Paul Whitaker
- Leeds Centre for Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom
| | - Daniel Peckham
- Leeds Centre for Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom.,Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom
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23
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Irgens EL, Henriksen N, Moe S. Communicating information and professional knowledge in acquired brain injury rehabilitation trajectories - a qualitative study of physiotherapy practice. Disabil Rehabil 2018; 42:2012-2019. [PMID: 30572746 DOI: 10.1080/09638288.2018.1544295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The communication of information and professional knowledge is paramount during patient transitions, and conveying practice knowledge is an important part of the health professional's role. Physiotherapy interventions in both specialist and primary health care are often necessary to aid persons in rehabilitation following an acquired brain injury (ABI). The aim of this study was to investigate how physiotherapists experience the way patient information is communicated across health care levels in ABI rehabilitation.Methods: We performed interviews with a total of 19 physiotherapists related to the rehabilitation trajectories of 10 people with acquired brain injuries. We performed a systematic text condensation analysis informed by constructionist and interactionist perspectives and theories of learning.Results: The physiotherapists in this study considered the patients to be complex and resource intensive. Written information upon hospital discharge was necessary but not sufficient, and they emphasized the need for verbal communication and closer collaboration across health care levels and clinical settings.Conclusions: The findings in this study indicate the need to improve routines for the communication of information and to clarify issues related to economy and responsibilities. Collaboration across health care levels require reciprocal understanding of the contextual differences in rehabilitation trajectories.Implications for rehabilitationThe discharge process is an important arena for continuous development of collaborative practices in the neurological rehabilitation context.Rehabilitation trajectories should be customized for the specific patient in a manner that is closely connected to contextual limitations and affordances.Communication between health care professionals in the transitional phase of rehabilitation trajectories is important to identify altered prerequisites for providing rehabilitation services in the primary care context.
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Affiliation(s)
- Eirik Lind Irgens
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Center for Care Research, North Norway, UiT The Arctic University of Norway, Tromsø, Norway
| | - Nils Henriksen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Center for Care Research, North Norway, UiT The Arctic University of Norway, Tromsø, Norway
| | - Siri Moe
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Center for Care Research, North Norway, UiT The Arctic University of Norway, Tromsø, Norway
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24
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Duignan M, Gibbons L, O'Connor L, Denning R, Honari B, McKenna K. GPs' opinions of discharge summaries generated by advanced nurse practitioners in emergency care settings. Emerg Nurse 2018; 26:19-27. [PMID: 30325136 DOI: 10.7748/en.2018.e1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 06/08/2023]
Abstract
AIM Clinical handover at the point of discharge is critically important. It generally occurs through a written document, usually in the form of a discharge summary. Hospital discharge summaries contribute to continuity of care for patients who leave hospital and who may require care in the community provided by their GP. They must be accurate, valid, reliable, timely, legible and complete. The aim of this study was to investigate GPs' perceptions of the content of discharge summaries generated by emergency advanced nurse practitioners (EANPs). METHOD A cross-sectional descriptive survey design was used and a questionnaire was distributed to 120 GPs. Raw statistical data were analysed using SPSS v22 while the qualitative data from the open-ended questions were manually analysed. FINDINGS Most GPs were satisfied with the EANPs' discharge summary letters. However, this study supports previous papers that identified deficits in communication between secondary care and GPs. CONCLUSION There is a need to refine discharge summaries to create an enhanced structured discharge summary template that can be used by all disciplines.
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Affiliation(s)
- Martin Duignan
- Emergency department, Our Lady's Hospital, Navan, Republic of Ireland
| | | | - Laserina O'Connor
- Graduate clinical studies, University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Republic of Ireland
| | - Ray Denning
- Our Lady's Hospital, Navan, Republic of Ireland
| | - Bahman Honari
- Arman Consultancy and Training Centre for Statistics and Mathematics, Dublin, Republic of Ireland
| | - Kevin McKenna
- Dundalk Institute of Technology, Republic of Ireland
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25
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Garcia BH, Djønne BS, Skjold F, Mellingen EM, Aag TI. Quality of medication information in discharge summaries from hospitals: an audit of electronic patient records. Int J Clin Pharm 2017; 39:1331-1337. [PMID: 29101617 DOI: 10.1007/s11096-017-0556-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
Background Low quality of medication information in discharge summaries from hospitals may jeopardize optimal therapy and put the patient at risk for medication errors and adverse drug events. Objective To audit the quality of medication information in discharge summaries and explore factors associated with the quality. Setting Helgelandssykehuset Mo i Rana, a rural hospital in central Norway. Method For each month in 2013, we randomly selected 60 discharge summaries from the Department of Medicine and Surgery (totally 720) and evaluated the medication information using eight Norwegian quality criteria. Main outcome measure Mean score per discharge summary ranging from 0 (lowest quality) to 16 (highest quality). Results Mean score per discharge summary was 7.4 (SD 2.8; range 0-14), significantly higher when evaluating medications used regularly compared to mediations used as needed (7.80 vs. 6.52; p < 0.001). Lowest score was achieved for quality criteria concerning generic names, indications for medication use, reasons why changes had been made and information about the source for information. Factors associated with increased quality scores are increasing numbers of medications and male patients. Increasing age seemed to be associated with a reduced score, while type of department was not associated with the quality. Conclusion In discharge summaries from 2013, we identified a low quality of medication information in accordance with the Norwegian quality criteria. Actions for improvement are necessary and follow-up studies to monitor quality are needed.
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Affiliation(s)
- Beate Hennie Garcia
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, 9037, Tromsø, Norway. .,Hospital Pharmacy of North Norway Trust (Sykehusapotek Nord HF), Postboks 6147, Langnes, 9291, Tromsø, Norway.
| | - Berit Svendsen Djønne
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, 9037, Tromsø, Norway
| | - Frode Skjold
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, 9037, Tromsø, Norway
| | - Ellen Marie Mellingen
- Hospital Pharmacy of North Norway Trust (Sykehusapotek Nord HF), Postboks 6147, Langnes, 9291, Tromsø, Norway.,Helgelandssykehuset Mo i Rana, Sjøforsgata 36, 8613, Mo i Rana, Norway
| | - Trine Iversen Aag
- Hospital Pharmacy of North Norway Trust (Sykehusapotek Nord HF), Postboks 6147, Langnes, 9291, Tromsø, Norway.,Helgelandssykehuset Mo i Rana, Sjøforsgata 36, 8613, Mo i Rana, Norway
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26
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Black M, Colford CM. Transitions of Care: Improving the Quality of Discharge Summaries Completed By Internal Medicine Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10613. [PMID: 30800815 PMCID: PMC6338163 DOI: 10.15766/mep_2374-8265.10613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/12/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Discharge summaries are now the accepted means of communication in transition from inpatient to ambulatory care. However, there is often no formal residency education on this critical document, leading to discordance in discharge summaries written by internal medicine residents. There is little in the literature focusing on teaching how to effectively create a discharge summary using an electronic health record (EHR). METHODS A 1-hour workshop was designed to teach components of the discharge summary and how to utilize this document to safely transition patients from the inpatient to the ambulatory setting. One or two faculty facilitators led the workshop with approximately 20 resident learners. A 50-point rubric was created to assess effectiveness of discharge summaries pre- and postworkshop. RESULTS The workshop was well received by residents and median scores on the rubric improved from 39 to 45 (p < .001) postworkshop. DISCUSSION We found that by teaching the concepts using examples of discharge summaries written by our residents, and then creating a standardized EHR template, residents wrote more effective discharge summaries with increased focus on the transition to the ambulatory provider. These materials can be applied to other programs and levels of learners to improve discharge summary quality. This serves to provide a resource to those at other institutions looking to create a more formalized didactic session on discharge summaries with a particular focus on transitioning care to the ambulatory provider.
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Affiliation(s)
- Meghan Black
- Clinical Instructor, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Cristin M. Colford
- Associate Professor, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
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27
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Using the Behaviour Change Wheel to identify interventions to facilitate the transfer of information on medication changes on electronic discharge summaries. Res Social Adm Pharm 2017; 13:456-475. [DOI: 10.1016/j.sapharm.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 11/15/2022]
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28
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Tahmasebian S, Langarizadeh M, Ghazisaeidi M, Safdari R. Semantic-Web Architecture for Electronic Discharge Summary Based on OWL 2.0 Standard. Acta Inform Med 2016; 24:182-5. [PMID: 27482132 PMCID: PMC4949045 DOI: 10.5455/aim.2016.24.182-185] [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: 01/31/2016] [Accepted: 03/25/2016] [Indexed: 11/09/2022] Open
Abstract
Introduction: Patients’ electronic medical record contains all information related to treatment processes during hospitalization. One of the most important documents in this record is the record summary. In this document, summary of the whole treatment process is presented which is used for subsequent treatments and other issues pertaining to the treatment. Using suitable architecture for this document, apart from the aforementioned points we can use it in other fields such as data mining or decision making based on the cases. Material and Methods: In this study, at first, a model for patient’s medical record summary has been suggested using semantic web-based architecture. Then, based on service-oriented architecture and using Java programming language, a software solution was designed and run in a way to generate medical record summary with this structure and at the end, new uses of this structure was explained. Results: in this study a structure for medical record summaries along with corrective points within semantic web has been offered and a software running within Java along with special ontologies are provided. Discussion and Conclusion: After discussing the project with the experts of medical/health data management and medical informatics as well as clinical experts, it became clear that suggested design for medical record summary apart from covering many issues currently faced in the medical records has also many advantages including its uses in research projects, decision making based on the cases etc.
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Affiliation(s)
- Shahram Tahmasebian
- Department of Health Information Management, School of Allied Medical Sciences, Tehran, University of Medical Sciences, Tehran, Iran
| | - Mostafa Langarizadeh
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeidi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran, University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran, University of Medical Sciences, Tehran, Iran
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Harper A, Jones P, Wimsett J, Stewart J, Le Fevre J, Wells S, Curtis E, Reid P, Ameratunga S. The effect of the Shorter Stays in Emergency Departments health target on the quality of ED discharge summaries. Emerg Med J 2016; 33:860-864. [DOI: 10.1136/emermed-2015-205601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/29/2016] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
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30
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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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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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