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Schwarz CM, Hoffmann M, Smolle C, Borenich A, Fürst S, Tuca AC, Holl AK, Gugatschka M, Grogger V, Kamolz LP, Sendlhofer G. Patient-centered discharge summaries to support safety and individual health literacy: a double-blind randomized controlled trial in Austria. BMC Health Serv Res 2024; 24:789. [PMID: 38982360 PMCID: PMC11234775 DOI: 10.1186/s12913-024-11183-w] [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] [Received: 05/19/2023] [Accepted: 06/06/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND To ensure a safe patient discharge from hospital it is necessary to transfer all relevant information in a discharge summary (DS). The aim of this study was to evaluate a bundle of measures to improve the DS for physicians, nurses and patients. METHODS In a double-blind, randomized, controlled trial, four different versions of DS (2 original, 2 revised) were tested with physicians, nurses and patients. We used an evaluation sheet (Case report form, CRF) with a 6-point Likert scale (1 = completely agree; 6 = strongly disagree). RESULTS In total, 441 participants (physicians n = 146, nurses n = 140, patients n = 155) were included in the study. Overall, the two revised DS received significant better ratings than the original DS (original 2.8 ± 0.8 vs. revised 2.1 ± 0.9, p < 0.001). Detailed results for the main domains are structured DS (original 1.9 ± 0.9 vs. revised 2.2 ± 1.3, p = 0.015), content (original 2.7 ± 0.9 vs revised 2.0 ± 0.9, p < 0.001) and comprehensibility (original 3.8 ± 1.2vs. revised 2.3 ± 1.2, p < 0.001). CONCLUSION With simple measures like avoiding abbreviations and describing indications or therapies with fixed contents, the DS can be significantly improved for physicians, nurses and patients at the same time. TRIAL REGISTRATION First registration 13/11/2020 NCT04628728 at www. CLINICALTRIALS gov , Update 15/03/2023.
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Affiliation(s)
- Christine Maria Schwarz
- Research Unit for Safety and Sustainability in Healthcare, 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 of Graz, Auenbruggerplatz 1/3, Graz, EG, A-8036, Austria
| | - Magdalena Hoffmann
- Research Unit for Safety and Sustainability in Healthcare, 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 of Graz, Auenbruggerplatz 1/3, Graz, EG, A-8036, Austria.
| | - Christian Smolle
- Research Unit for Safety and Sustainability in Healthcare, c/o, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz, Graz, Austria
| | - Andrea Borenich
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Stefan Fürst
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexandru-Cristian Tuca
- Research Unit for Safety and Sustainability in Healthcare, c/o, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz, Graz, Austria
| | - Anna Katharina Holl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Markus Gugatschka
- Division of Phoniatrics, Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - Victor Grogger
- Department for Medical Informatics and Processes, University Hospital of Graz, KAGes, Graz, Austria
| | - Lars-Peter Kamolz
- Research Unit for Safety and Sustainability in Healthcare, c/o, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery , Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety and Sustainability in Healthcare, 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 of Graz, Auenbruggerplatz 1/3, Graz, EG, A-8036, Austria
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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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Rajkomar A, Loreaux E, Liu Y, Kemp J, Li B, Chen MJ, Zhang Y, Mohiuddin A, Gottweis J. Deciphering clinical abbreviations with a privacy protecting machine learning system. Nat Commun 2022; 13:7456. [PMID: 36460656 PMCID: PMC9718734 DOI: 10.1038/s41467-022-35007-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
Physicians write clinical notes with abbreviations and shorthand that are difficult to decipher. Abbreviations can be clinical jargon (writing "HIT" for "heparin induced thrombocytopenia"), ambiguous terms that require expertise to disambiguate (using "MS" for "multiple sclerosis" or "mental status"), or domain-specific vernacular ("cb" for "complicated by"). Here we train machine learning models on public web data to decode such text by replacing abbreviations with their meanings. We report a single translation model that simultaneously detects and expands thousands of abbreviations in real clinical notes with accuracies ranging from 92.1%-97.1% on multiple external test datasets. The model equals or exceeds the performance of board-certified physicians (97.6% vs 88.7% total accuracy). Our results demonstrate a general method to contextually decipher abbreviations and shorthand that is built without any privacy-compromising data.
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Affiliation(s)
- Alvin Rajkomar
- grid.420451.60000 0004 0635 6729Google, Mountain View, CA USA
| | - Eric Loreaux
- grid.420451.60000 0004 0635 6729Google, Mountain View, CA USA
| | - Yuchen Liu
- grid.420451.60000 0004 0635 6729Google, Mountain View, CA USA
| | - Jonas Kemp
- grid.420451.60000 0004 0635 6729Google, Mountain View, CA USA
| | - Benny Li
- grid.420451.60000 0004 0635 6729Google, Mountain View, CA USA
| | - Ming-Jun Chen
- grid.420451.60000 0004 0635 6729Google, Mountain View, CA USA
| | - Yi Zhang
- grid.420451.60000 0004 0635 6729Google, Mountain View, CA USA
| | - Afroz Mohiuddin
- grid.420451.60000 0004 0635 6729Google, Mountain View, CA USA
| | - Juraj Gottweis
- grid.420451.60000 0004 0635 6729Google, Mountain View, CA USA
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Schwarz CM, Hoffmann M, Smolle C, Eiber M, Stoiser B, Pregartner G, Kamolz LP, Sendlhofer G. Structure, content, unsafe abbreviations, and completeness of discharge summaries: A retrospective analysis in a University Hospital in Austria. J Eval Clin Pract 2021; 27:1243-1251. [PMID: 33421263 PMCID: PMC9290607 DOI: 10.1111/jep.13533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVE The discharge summary (DS) is one of the most important instruments to transmit information to the treating general physician (GP). The objective of this study was to analyse important components of DS, structural characteristics as well as medical and general abbreviations. METHOD One hundred randomly selected DS from five different clinics were evaluated by five independent reviewers regarding content, structure, abbreviations and conformity to the Austrian Electronic Health Records (ELGA) using a structured case report form. Abbreviations of all 100 DS were extracted. All items were scored on a 4-point Likert-type scale ranging from "strongly agree" to "strongly disagree" (or "not relevant"). Subsequently, the results were discussed among reviewers to achieve a consensus decision. RESULTS The mandatory fields, reason for admission and diagnosis at discharge were present in 80% and 98% of DS. The last medication was fully scored in 48% and the recommended medication in 94% of 100 DS. There were significant overall differences among clinics for nine mandatory items. In total, 750 unexplained abbreviations were found in 100 DS. CONCLUSIONS In conclusion, DS are often lacking important items. Particularly important are a detailed medication history and recommendations for further medication that should always be listed in each DS. It is thus necessary to design and implement changes that improve the completeness of DS. An important quality improvement can be achieved by avoiding the use of ambiguous abbreviations.
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Affiliation(s)
- Christine Maria Schwarz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Magdalena Hoffmann
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christian Smolle
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Michael Eiber
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Bianca Stoiser
- Department of Management, Health Management in Tourism, University of Applied Sciences, Bad Gleichenberg, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics und Documentation, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
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Design and preliminary evaluation of a newly designed patient-friendly discharge letter - a randomized, controlled participant-blind trial. BMC Health Serv Res 2021; 21:450. [PMID: 33975590 PMCID: PMC8114527 DOI: 10.1186/s12913-021-06468-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low health literacy has been associated with poor health outcome and impaired use of healthcare services. The hospital discharge letter represents a key source of medical information for patients and can be used to address the problem of low health literacy. The aim of this project was to develop and evaluate a new, patient-directed, version of the discharge letter. METHODS Based upon two conventional discharge letters (CDL; one surgical and one medical letter), two new, patient-friendly discharge letters (PFDL) were designed following 5 key principles: short sentences, few abbreviations, large font size, avoidance of technical terms and no more than 4 pages length. Medical undergraduates were randomized into two blinded groups (CDL, PFDL) and asked to assess the assigned letter for the 3 domains structure, content and patient-friendliness. Subsections were rated on a 6-point Likert scale (1 = completely agree, 6 = completely disagree), the results of the survey were compared using the Mann-Whitney-U-Test with a p < 0.05 being the level of significance. RESULTS In total, 74 undergraduates participated in this study. PFDL (35 participants) were rated significantly better than CDL (39 participants) regarding structure (median 1 vs. 2, p = 0.005), content (1 vs. 3, p < 0.001) and patient-friendliness (2 vs. 6, p < 0.001). Of all 17 subsections, PFDL were rated significantly better in 12 cases, and never worse than CDL. CONCLUSIONS PFDL were rated significantly better than their CDL counterparts. Medical undergraduates were considered the ideal cohort, not being medical lays and yet unbiased regarding everyday clinical practice procedures. Further tests evaluating the impact of the PFDL on patient comprehension and health literacy are necessary.
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