The Housestaff Incentive Program: improving the timeliness and quality of discharge summaries by engaging residents in quality improvement

BMJ Qual Saf. 2013 Sep;22(9):768-74. doi: 10.1136/bmjqs-2012-001671. Epub 2013 May 23.

Abstract

Background: Quality improvement has become increasingly important in the practice of medicine; however, engaging residents in meaningful projects within the demanding training environment remains challenging.

Methods: We conducted a year-long quality improvement project involving internal medicine residents at an academic medical centre. Resident champions designed and implemented a discharge summary improvement bundle, which employed an educational curriculum, an electronic discharge summary template, regular data feedback and a financial incentive. The timeliness and quality of discharge summaries were measured before and after the intervention. Residents and faculty were surveyed about their perceptions of the project; primary care providers were surveyed about their satisfaction with hospital provider communication.

Results: With implementation of the bundle, the average time from patient discharge to completion of the discharge summary fell from 3.5 to 0.61 days (p<0.001). The percentage of summaries completed on the day of discharge rose from 38% to 83% (p<0.001) and this improvement was sustained for 6 months following the end of the project. The percentage of summaries that included all recommended elements increased from 5% to 88% (p<0.001). Primary care providers reported a lower likelihood of discharge summaries being unavailable at the time of outpatient follow-up (38% to 4%, p<0.001). Residents reported that the systems changes, more than the financial incentive, accounted for their behaviour change.

Conclusions: Our discharge summary improvement project provides an instructive example of how residents can lead clinically meaningful quality improvement projects.

Keywords: Financial incentives; Graduate medical education; Information technology; Quality improvement; Transitions in care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • California
  • Humans
  • Internal Medicine / standards
  • Internship and Residency / standards
  • Medical Staff, Hospital*
  • Patient Discharge Summaries / standards*
  • Physician Incentive Plans*
  • Quality Improvement*
  • Surveys and Questionnaires
  • Time Factors