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Appl Clin Inform 2018; 09(03): 734-742
DOI: 10.1055/s-0038-1669461
Research Article

Integrated Electronic Discharge Summaries—Experience of a Tertiary Pediatric Institution

Daryl R. Cheng
1   EMR Project Team, The Royal Children's Hospital Melbourne, Parkville, Australia
2   Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
,
Merav L. Katz
1   EMR Project Team, The Royal Children's Hospital Melbourne, Parkville, Australia
,
Mike South
1   EMR Project Team, The Royal Children's Hospital Melbourne, Parkville, Australia
2   Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
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Abstract

Objective Succinct and timely discharge summaries (DSs) facilitate ongoing care for patients discharged from acute care settings. Many institutions have introduced electronic DS (eDS) templates to improve quality and timeliness of clinical correspondence. However, significant intrahospital and intraunit variability and application exists. A review of the literature and guidelines revealed 13 key elements that should be included in a best practice DS. This was compared against our pediatric institution's eDS template—housed within an integrated electronic medical record (EMR) and used across most inpatient hospital units.

Methods Uptake and adherence to the suggested key elements was measured by comparing all DSs for long stay inpatients (> 21-day admission) during the first year of the EMR eDS template's usage (May 2016–April 2017).

Results A total of 472 DSs were evaluated. Six of 13 key elements were completed in > 98.0% of DSs. Conversely, only < 5.0% included allergies or adverse reaction data, and < 11.0% included ceased medications or pending laboratory results. Inclusion of procedure information and pending laboratory results significantly improved with time (p = 0.05 and p < 0.04, respectively), likely as doctors became more familiar with EMR and autopopulation functions. Inclusion of “discharge diagnosis” differed significantly between medical (n = 406/472; 99.0%) and surgical (n = 32/472; 51.6%) DSs.

Conclusion Uptake and adherence to an EMR eDS template designed to meet best practice guidelines in a pediatric institution was strong, although significant improvements in specific data elements are needed. Strategies can include a modification of existing eDS templates and junior medical staff education around best practice.

Keywords

best practice - discharge summaries - electronic medical records - template

Protection of Human and Animal Subjects

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by RCH Human Research Ethics Committee (HREC #DA001-2017-102).




Publication History

Received: 18 April 2018

Accepted: 29 July 2018

Publication Date:
19 September 2018 (online)

© 2018. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Belleli E, Naccarella L, Pirotta M. Communication at the interface between hospitals and primary care - a general practice audit of hospital discharge summaries. Aust Fam Physician 2013; 42 (12) 886-890
    PubMedGoogle Scholar
  • 2 Embi PJ, Yackel TR, Logan JR, Bowen JL, Cooney TG, Gorman PN. Impacts of computerized physician documentation in a teaching hospital: perceptions of faculty and resident physicians. J Am Med Inform Assoc 2004; 11 (04) 300-309
    CrossrefPubMedGoogle Scholar
  • 3 Alderton M, Callen J. Are general practitioners satisfied with electronic discharge summaries?. Health Inf Manag 2007; 36 (01) 7-12
    PubMedGoogle Scholar
  • 4 Forster AJ, Clark HD, Menard A. , et al. Adverse events among medical patients after discharge from hospital. CMAJ 2004; 170 (03) 345-349
    PubMedGoogle Scholar
  • 5 Chan S, Maurice AP, Pollard CW, Ayre SJ, Walters DL, Ward HE. Improving the efficiency of discharge summary completion by linking to preexisiting patient information databases. BMJ Qual Improv Rep 2014; 3 (01) u200548.w2006
    CrossrefPubMedGoogle Scholar
  • 6 Hahn JS, Bernstein JA, McKenzie RB, King BJ, Longhurst CA. Rapid implementation of inpatient electronic physician documentation at an academic hospital. Appl Clin Inform 2012; 3 (02) 175-185
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Australian Commission on Safety and Quality in Healthcare. National guidelines for on-screen presentation of discharge summaries. Sydney, NSW: Commonwealth Government of Australia; April 01 2016. Available at: Accessed August 14, 2018 https://www.safetyandquality.gov.au/wp-content/uploads/2017/02/Guidelines-on-screen-presentation-of-discharge-summaries.pdf
    PubMed
  • 8 O'Leary KJ, Liebovitz DM, Feinglass J, Liss DT, Baker DW. Outpatient physicians' satisfaction with discharge summaries and perceived need for an electronic discharge summary. J Hosp Med 2006; 1 (05) 317-320
    CrossrefPubMedGoogle Scholar
  • 9 Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 2007; 297 (08) 831-841
    CrossrefPubMedGoogle Scholar
  • 10 Wilson S, Ruscoe W, Chapman M, Miller R. General practitioner-hospital communications: a review of discharge summaries. J Qual Clin Pract 2001; 21 (04) 104-108
    CrossrefPubMedGoogle Scholar
  • 11 Schabetsberger T, Ammenwerth E, Andreatta S. et al. From a paper-based transmission of discharge summaries to electronic communication in health care regions. Int J Med Inform 2006; 75 (3-4): 209-215
    CrossrefPubMedGoogle Scholar
  • 12 O'Leary KJ, Liebovitz DM, Feinglass J. , et al. Creating a better discharge summary: improvement in quality and timeliness using an electronic discharge summary. J Hosp Med 2009; 4 (04) 219-225
    CrossrefPubMedGoogle Scholar
  • 13 Australian Commission on Safety and Quality in Healthcare. Electronic Discharge Summary Systems Literature Scan. Sydney, NSW: Commonwealth Government of Australia; August 2 2010. Available at: https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/e-DischargeLiteratureScan.pdf. Accessed August 14, 2017
    PubMed
  • 14 Patel VL, Kushniruk AW, Yang S, Yale JF. Impact of a computer-based patient record system on data collection, knowledge organization, and reasoning. J Am Med Inform Assoc 2000; 7 (06) 569-585
    CrossrefPubMedGoogle Scholar
  • 15 van Walraven C, Rokosh E. What is necessary for high-quality discharge summaries?. Am J Med Qual 1999; 14 (04) 160-169
    CrossrefPubMedGoogle Scholar
  • 16 Buckler LT, Teasdale C, Turner M, Schadler A, Schwieterman TM, Campbell CL. The patient-centered discharge-an electronic discharge process is associated with improvements in quality and patient satisfaction. J Healthc Qual 2017; 39 (03) 136-143
    CrossrefPubMedGoogle Scholar
  • 17 Rosenbloom ST, Crow AN, Blackford JU, Johnson KB. Cognitive factors influencing perceptions of clinical documentation tools. J Biomed Inform 2007; 40 (02) 106-113
    CrossrefPubMedGoogle Scholar
  • 18 Coghlin DT, Leyenaar JK, Shen M. , et al. Pediatric discharge content: a multisite assessment of physician preferences and experiences. Hosp Pediatr 2014; 4 (01) 9-15
    CrossrefPubMedGoogle Scholar
  • 19 Leyenaar JK, Bergert L, Mallory LA. , et al. Pediatric primary care providers' perspectives regarding hospital discharge communication: a mixed methods analysis. Acad Pediatr 2015; 15 (01) 61-68
    CrossrefPubMedGoogle Scholar
  • 20 Allen-Graham J, Mitchell L, Heriot N. , et al. Electronic health records and online medical records: an asset or a liability under current conditions?. Aust Health Rev 2018; 42 (01) 59-65
    CrossrefPubMedGoogle Scholar
  • 21 Snow V, Beck D, Budnitz T. , et al; American College of Physicians; Society of General Internal Medicine; Society of Hospital Medicine; American Geriatrics Society; American College of Emergency Physicians; Society of Academic Emergency Medicine. Transitions of care consensus policy statement: American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine. J Gen Intern Med 2009; 24 (08) 971-976
    CrossrefPubMedGoogle Scholar
  • 22 Hammad EA, Wright DJ, Walton C, Nunney I, Bhattacharya D. Adherence to UK national guidance for discharge information: an audit in primary care. Br J Clin Pharmacol 2014; 78 (06) 1453-1464
    CrossrefPubMedGoogle Scholar
  • 23 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 (06) 630-639
    CrossrefPubMedGoogle Scholar
  • 24 Australian Digital Health Agency. My Health Record; 2017. Available at: https://www.digitalhealth.gov.au/get-started-with-digital-health/what-is-digital-health/features-of-the-my-health-record-system/my-health-record-system-healthcare-identifiers. Accessed August 20, 2017
    PubMed
  • 25 Fathi R, Davis A, Campbell K. Discharge summaries for hospital to intermediate care facility transitions: assessing timeliness and quality of documentation by Internal Medicine residents. J Am Geriatr Soc 2013; (61) S107
    PubMedGoogle Scholar
  • 26 Callen J, McIntosh J, Li J. Accuracy of medication documentation in hospital discharge summaries: a retrospective analysis of medication transcription errors in manual and electronic discharge summaries. Int J Med Inform 2010; 79 (01) 58-64
    CrossrefPubMedGoogle Scholar
  • 27 Walz SE, Smith M, Cox E, Sattin J, Kind AJ. Pending laboratory tests and the hospital discharge summary in patients discharged to sub-acute care. J Gen Intern Med 2011; 26 (04) 393-398
    CrossrefPubMedGoogle Scholar
  • 28 Hart C, Stevens T, Girling N. Are our discharge summaries fit for purpose?. Palliat Med 2016; 30 (06) NP212-NP213
    PubMedGoogle Scholar
  • 29 Boxer R, Gandara E, Schnipper J. Introduction of a discharge template to improve discharge documentation for patients with heart failure. J Hosp Med 2010;5(S1). Available at: https://www.shmabstracts.com/abstract/introduction-of-a-discharge-template-to-improve-discharge-documentation-for-patients-with-heart-failure/. Accessed August 31, 2018
    PubMedGoogle Scholar
  • 30 Key-Solle M, Paulk E, Bradford K, Skinner AC, Lewis MC, Shomaker K. Improving the quality of discharge communication with an educational intervention. Pediatrics 2010; 126 (04) 734-739
    CrossrefPubMedGoogle Scholar
  • 31 Grimes T, Fitzsimons M, Galvin M, Delaney T, Flanagan S. Evaluation of dispensing records from the Primary Care Reimbursement Services as a source of preadmission medication information. Pharmacoepidemiol Drug Saf 2011; 20 (06) 663
    PubMedGoogle Scholar
  • 32 Davis T. Paediatric prescribing errors. Arch Dis Child 2011; 96 (05) 489-491
    CrossrefPubMedGoogle Scholar
  • 33 Gattari TB, Krieger LN, Hu HM, Mychaliska KP. Medication discrepancies at pediatric hospital discharge. Hosp Pediatr 2015; 5 (08) 439-445
    CrossrefPubMedGoogle Scholar
  • 34 Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 2003; 18 (08) 646-651
    CrossrefPubMedGoogle Scholar
  • 35 Li JY, Yong TY, Hakendorf P, Ben-Tovim D, Thompson CH. Timeliness in discharge summary dissemination is associated with patients' clinical outcomes. J Eval Clin Pract 2013; 19 (01) 76-79
    CrossrefPubMedGoogle Scholar
  • 36 Feigenbaum P, Neuwirth E, Trowbridge L. , et al. Factors contributing to all-cause 30-day readmissions: a structured case series across 18 hospitals. Med Care 2012; 50 (07) 599-605
    CrossrefPubMedGoogle Scholar
  • 37 Tsou AY, Lehmann CU, Michel J, Solomon R, Possanza L, Gandhi T. Safe practices for copy and paste in the EHR. Systematic review, recommendations, and novel model for health IT collaboration. Appl Clin Inform 2017; 8 (01) 12-34
    PubMedGoogle Scholar
  • 38 Adhiyaman V, Oke A, White AD, Shah IU. Diagnoses in discharge communications: how far are they reliable?. Int J Clin Pract 2000; 54 (07) 457-458
    CrossrefPubMedGoogle Scholar
  • 39 Bowman S. Impact of electronic health record systems on information integrity: quality and safety implications. Perspect Health Inf Manag 2013; 10: 1c
    PubMedGoogle Scholar
  • 40 Dean SM, Gilmore-Bykovskyi A, Buchanan J, Ehlenfeldt B, Kind AJ. Design and hospitalwide implementation of a standardized discharge summary in an electronic health record. Jt Comm J Qual Patient Saf 2016; 42 (12) 555-AP11
    PubMedGoogle Scholar