A Hospital Discharge Summary Quality Improvement Program Featuring Individual and Team-based Feedback and Academic Detailing

BackgroundDischarge summaries are an important component of hospital care transitions typically completed by interns in teaching hospitals. However, these documents are often not completed in a timely fashion or do not include pertinent details of hospitalization. This report outlines the development and impact of a curriculum intervention to improve the quality of discharge summaries by interns and residents in Internal Medicine. A previous study demonstrated that a discharge summary curriculum featuring individualized feedback was associated with improved summary quality, but few subsequent studies have described implementation of similar curricula. No information exists on the utility of other strategies such as team-based feedback or academic detailing.MethodsStudy participants were 96 Internal Medicine intern and resident physicians at an academic medical center-based training program. A comprehensive evidence-based discharge summary quality improvement program was developed and implemented that featured a discharge summary template to facilitate summary preparation, individual feedback, team-based feedback, academic detailing and an objective discharge summary evaluation instrument.ResultsThe discharge summary evaluation instrument had moderate interrater reliability (κ = 0.72). Discharge summary scores improved from mean score of 70% to 82% (P = 0.05). Interns and residents participating in this program also reported increased confidence in producing and critiquing summaries.ConclusionsA comprehensive discharge summary curriculum can be feasibly implemented within the context of a residency program. Team-based feedback and academic detailing may serve to reinforce individual feedback and extend program reach.