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Opportunities to improve clinical summaries for patients at hospital discharge
  1. Erin Sarzynski1,2,
  2. Hamza Hashmi3,
  3. Jeevarathna Subramanian3,
  4. Laurie Fitzpatrick1,
  5. Molly Polverento1,2,
  6. Michael Simmons4,
  7. Kevin Brooks2,
  8. Charles Given1,2
  1. 1Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
  2. 2Institute for Health Policy, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
  3. 3Grand Rapids Medical Education Partners, Grand Rapids, Michigan, USA
  4. 4Sparrow Health System, Lansing, Michigan, USA
  1. Correspondence to Dr Erin Sarzynski, Michigan State University College of Human Medicine, 965 Fee Road, East Lansing, MI 48824, USA; erin.sarzynski{at}hc.msu.edu

Abstract

Background Clinical summaries are electronic health record (EHR)-generated documents given to hospitalised patients during the discharge process to review their hospital stays and inform postdischarge care. Presently, it is unclear whether clinical summaries include relevant content or whether healthcare organisations configure their EHRs to generate content in a way that promotes patient self-management after hospital discharge. We assessed clinical summaries in three relevant domains: (1) content; (2) organisation; and (3) readability, understandability and actionability.

Methods Two authors performed independent retrospective chart reviews of 100 clinical summaries generated at two Michigan hospitals using different EHR vendors for patients discharged 1 April –30 June 2014. We developed an audit tool based on the Meaningful Use view-download-transmit objective and the Society of Hospital Medicine Discharge Checklist (content); the Institute of Medicine recommendations for distributing easy-to-understand print material (organisation); and five readability formulas and the Patient Education Materials Assessment Tool (readability, understandability and actionability).

Results Clinical summaries averaged six pages (range 3–12). Several content elements were universally auto-populated into clinical summaries (eg, medication lists); others were not (eg, care team). Eighty-five per cent of clinical summaries contained discharge instructions, more often generated from third-party sources than manually entered by clinicians. Clinical summaries contained an average of 14 unique messages, including non-clinical elements irrelevant to postdischarge care. Medication list organisation reflected reconciliation mandates, and dosing charts, when present, did not carry column headings over to subsequent pages. Summaries were written at the 8th–12th grade reading level and scored poorly on assessments of understandability and actionability. Inter-rater reliability was strong for most elements in our audit tool.

Conclusions Our study highlights opportunities to improve clinical summaries for guiding patients' postdischarge care.

  • Medication safety
  • Health services research
  • Patient-centred care
  • Patient education

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