BMJ Qual Saf doi:10.1136/bmjqs-2011-000441
  • Innovations in Education

The effects of a ‘discharge time-out’ on the quality of hospital discharge summaries

  1. Jeff Schnipper1,2,4
  1. 1BWH Academic Hospitalist Service, Boston, Massachusetts, USA
  2. 2Division of General Medicine and Primary Care, Boston, Massachusetts, USA
  3. 3Brigham and Women's Hospital, Partners Healthcare, Boston, Massachusetts, USA
  4. 4Harvard Medical School, Boston, Massachusetts, USA
  5. 5Internal Medicine Residency Program, Boston, Massachusetts, USA
  1. Correspondence to Dr Prashant Vaishnava, Mount Sinai Medical Center, 1468 Madison Avenue, New York, NY 10029, USA; prashant.vaishnava{at}
  1. Contributors NSM, PV, SY and JLS: conception of design, acquisition of data, analysis of data, generation of the article and critical revision; CLL, MV and AD: conception of design, acquisition of data, analysis of data and generation of the article.

  • Accepted 27 March 2012
  • Published Online First 5 May 2012


Background High-quality discharge summaries are a key component of a safe transition in care. The purpose of this study was to determine the effects of standardised feedback and a ‘discharge time-out’ (DTO) on the quality of discharge summaries.

Methods During 2006–2007, the authors trained hospitalists to provide two interventions at their discretion: (1) feedback on one discharge summary to each intern using a standardised form and (2) a DTO, modelled after the surgical time-out, in which key questions about the patient's hospital course and discharge plan are answered verbally by the intern during rounds on the day of discharge. To evaluate these interventions, trained clinicians, blinded to group assignment, performed an explicit review of two discharge summaries before and after intervention implementation. The authors used a mixed linear model to evaluate relative improvement over time.

Results The authors compared 14 interns who only received a 1-h lecture and a small-group resident-led training session with 13 interns who also received feedback and 12 interns who received feedback and a DTO. Save greater improvement in the documentation of tasks to be completed after discharge (39% vs 8% absolute improvement, p=0.05) by interns receiving an intervention, most domains were unaffected by having received a DTO and/or feedback.

Conclusion These results suggest that standardised feedback and a DTO integrated into attending rounds have limited potential to improve discharge summaries as currently designed. This study stresses the need for developing and refining interventions that can improve the narrative flow of discharge summaries.


  • Competing interests None.

  • Ethics approval The ethics approval was provided by the Partners Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data available on request from the corresponding author.

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