Improving the Quality of Paediatric Discharge Summaries at the University Teaching Hospital: A Retrospective Chart Review

Abstract

Introduction: The Discharge Summary (DS) is a vital document for ongoing patient care. Poor quality of DS may lead to adverse events, medication errors, readmission, or unnecessary repetition of diagnostic work-ups. DSs provided by academic institutions may not meet expectations and, therefore, need to be evaluated. Aim: To improve the quality of DSs issued from the paediatric ward of a tertiary-care teaching hospital. Materials and Methods: The present retrospective chart review was conducted in the Department of Paediatrics, Shree Krishna Hospital (a rural tertiary care teaching hospital), Karamsad, Gujarat, India, from May 2018 to May 2020. Thirtythree summaries were randomly selected from the last quarter (October to December) of each calendar year 2017, 2018, and 2019 (a total of 99 summaries), representing the pre-intervention, post-intervention, and retention phases, respectively. In the absence of a contextual paediatric DS assessment tool, a novel scoring system was developed to evaluate 33 components of the DS under seven broad domains. This scoring system was consensually validated. Residents responsible for preparing the DS were empowered in small groups. Peer audits of the summaries prepared by each resident were conducted on multiple occasions by consultants, followed by feedback highlighting areas for improvement. Review of the summaries by senior residents or consultants were promoted. Discussions on discharge processes were emphasised during ward rounds including important DS documentation points. The percentage mean±Standard Deviation (SD) domain scores and the total final score were compared using Analysis of Variance (ANOVA) with post-hoc comparisons by Scheffe’s test using Statistics and Data (STATA) software version 14.2. Results: Out of 33 summaries from 2017, one patient file was not traceable at the time of the study, and reviews of 30 and 32 DSs could be reviewed for the years 2018 and 2019, respectively. The scoring tool demonstrated good inter-rater reliability. The mean±SD total % score was 78.50±8.23 in 2017, 85.48±8.91 in 2018, and 88.48±9.05 in 2019. There was a significant improvement (p-value=0.012) from 2017 to 2018. Domains such as history, physical examination, and discharge plan showed significant improvement, while the hospital course domain remained resistant to improvement. Conclusion: The DS score improved consecutively for both years. The quality of DSs prepared by residents in a teaching institute can be enhanced through education, audit feedback, and changes in the work system. These methods can be incorporated into postgraduate training to improve documentation.

Keywords

• discharge planning
• documentation
• medical education
• quality improvement