Evaluation of electronic discharge summaries: A comparison of documentation in electronic and handwritten discharge summaries
This is the first review of the article "Evaluation of electronic discharge summaries: A comparison of documentation in electronic and handwritten discharge summaries."
Background and Objective
In this study a comparison between handwritten or dictated discharge summaries is done with the electronically created discharge summaries. This study was conducted in Australia after installing a system that can create discharge summaries electronically in a teaching hospital. The objectives of this study were two fold: first to evaluate the quality of discharge summaries per se and second to compare electronic discharge summaries with the handwritten or dictated ones for deficiencies or omissions. This was a retrospective study and compared electronic discharge summaries created using templates in Electronic Health Records (EHRs) with either handwritten or dictated ones.
A total of 245 eligible discharge summaries were identified. Out of these discharge summaries, 151 were electronically completed and 94 were handwritten. These discharge summaries were then evaluated for their completion. The following criteria were used: discharge date, additional diagnosis, summary of the hospital course; discharge medication and follow-up plans. These plans were to be executed by the PCP’s.
Data analysis showed that electronic discharge summaries had a higher number of errors as compared to the handwritten ones. However, most errors were related to omission of discharge date. Handwritten discharge summaries on the other hand missed summary of the hospital course. One interesting finding was that overall medication error rate was small in both electronic and handwritten ones.
The authors concluded that electronic discharge summaries necessarily are not better as compared to the handwritten ones, but were unable to satisfactorily identify factors that led to incomplete discharge summaries. In addition, two physicians who completed the most electronic discharge summaries had most errors of omission in discharge date. This may be related to the inadequate training to these physicians and could have resulted in different findings had these physicians received a timely feedback.
I used this article for many reasons; first of all with fragmented healthcare in US, a complete discharge summary is a very important tool to provide continuity of care. Second, though hospital bylaws usually dictate that a discharge summary should be completed in a timely manner and there is an expectation that discharge summaries should conform to some standards, there is generally no regular audit for the completeness or quality of the discharge summaries. EHR’s represents an opportunity to provide improvement in this area by creating a template in which specific components of the discharge summary can be auto-populated and allows for inclusion of other items from the coded data as needed. In addition a template that with some modification can duplicate as discharge instructions to the patient. This may help provide better discharge instructions and in an article Relationship of health literacy to intentional and unintentional non-adherence of hospital discharge medications.  may help reduce medication errors. A properly developed electronic discharge summary template which may allow physicians to create discharge instructions may increase physician satisfaction. In a quasi experimental study Information Technology Improves Emergency Department Patient Discharge Instructions Completeness and Performance on a National Quality Measure the authors compared the completeness of ED discharge instructions created through the use of an electronic discharge module with the hand written ones and found that the ED discharge instructions were more complete when the ED physicians used the electronic discharge instruction module.
- Joanne L. Callen, Melanie Alderton, Jean McIntosh, Evaluation of electronic discharge summaries: A comparison of documentation in electronic and handwritten discharge summaries, International Journal of Medical Informatics, Volume 77, Issue 9, September 2008, Pages 613-620, ISSN 1386-5056, http://dx.doi.org/10.1016/j.ijmedinf.2007.12.002. (http://www.sciencedirect.com/science/article/pii/S1386505608000026) Keywords: Electronic discharge summary; Handwritten discharge summary; Hospital discharge; Discharge communication; Australia
- Relationship of health literacy to intentional and unintentional non-adherence of hospital discharge medications.Lindquist LA1, Go L, Fleisher J, Jain N, Friesema E, Baker DW.J Gen Intern Med. 2012 Feb;27(2):173-8. doi: 10.1007/s11606-011-1886-3. Epub 2011 Oct 5.http://www.ncbi.nlm.nih.gov/pubmed/21971600