Key result
Departmental quality improvement interventions raise discharge summary scores by ~0.6 points on a five-point scale.
Why the study?
Discharge summaries are critical for safe patient transitions, prompting an effort to improve their quality through continual departmental audit against the National Standard for Discharge Summary Information.
Do targeted interventions including education, flowcharts, and weekly reports improve discharge summary quality in a geriatric medicine service?
Do targeted interventions including education, flowcharts, and weekly reports improve discharge summary quality in a geriatric medicine service?
Effect estimate: +0.63 points
p-value: p=0.022
A continual audit combined with targeted educational and administrative interventions significantly improved the quality of discharge summaries in a geriatric medicine service.
May support similar QI bundles in geriatric units; supports consensus but leaves generalizability open.
Background Discharge summaries are a vital method of communication and critical for safe patient transitions. We sought to improve the quality of our discharge summaries through continual departmental audit against the National Standard for Discharge Summary Information (HIQA, 2013). We compared results across four audit cycles since 2022. Methods In each audit, 20 patients were selected at random from the preceding three months. Their electronic discharge summary and paper based medical notes were compared against the HIQA standards. Five key elements were examined: clinical course, complications, primary diagnosis, discharge medications and follow-up. Post Cycle1 interventions included creating an NCHD-designed flowchart, targeted education sessions and weekly reports on outstanding summaries to consultants. Data was analysed using Stata V15. Binary outcomes were compared between Cycle 1 and Cycles 2–4 using Pearson’s Chi-square test (p < 0.05). A composite outcome (5 key elements) was analysed using logistic regression. Results Significant improvements were made and sustained in documentation of the clinical course (40%-75%, p = 0.004), primary diagnosis (85%-100%, p = 0.002), and stopped medications (40%-70%, p = 0.016). Communication of future-plans (85%-97%, p = 0.062) and ideal summaries (20%-40%, p = 0.104) showed positive trends but did not reach statistical significance. Documentation of new or changed medications (85%-75%, p = 0.354), complications (80%-85%, p = 0.600), and complete discharge medications (57%-60%, p = 0.794) remained stable across cycles. Discharge summary quality improved significantly across cycles, with Cycles 2–4 scoring 0.63 points higher on a 5-point composite scale than Cycle 1 (p = 0.022). Conclusion NCHD-led continual audit, education sessions, a targeted flowchart and weekly reports resulted in significant and sustained improvements in the quality of discharge summaries. In addition to these interventions, we recommend the implementation of end-to-end electronic patient records to improve the accuracy of medication documentation.
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Murphy et al. (2025) studied Discharge summary quality (n=80). NCHD-designed flowchart, targeted education sessions, and weekly reports vs. Cycle 1 (baseline) was evaluated on 5-point composite scale of discharge summary quality (clinical course, complications, primary diagnosis, discharge medications, and follow-up) (+0.63 points, p=0.022). A departmental quality improvement intervention comprising education, a flowchart, and weekly reports improved discharge summary quality by 0.63 points on a 5-point composite scale (p=0.022).
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