Triple Duty: Integrating Graduate Medical Education With Maintenance of Board Certification to Improve Clinician Communication at Hospital Discharge

BACKGROUND: Complete and accurate discharge summaries can improve communication and continuity of care between inpatient and ambulatory settings as well as reduce adverse events. However, discharge summaries commonly lack key information. OBJECTIVE: To determine if a quality improvement intervention that actively engages residents and attending physicians would improve the timeliness and quality of hospital discharge summaries at our academic children's hospital, and would help trainees and clinicians complete educational requirements. METHODS: Electronic health record queries were used to assess time to completion of discharge summaries. A total of 120 discharge summaries from 36 eligible residents were reviewed by 9 attending pediatricians using an objective discharge summary scoring instrument. Improvement was facilitated through monthly learning sessions and Plan-Do-Study-Act cycles. RESULTS: The proportion of summaries completed within 24 hours of discharge increased from 38% to 73%; mean discharge summary scores improved from 54% to 99%; and percentage of summaries that included all 13 elements in the scoring instrument increased from 0% to 80%. All elements most likely to be deficient at baseline showed a higher likelihood of being included in summaries following the intervention. The rate of summaries that were scored as containing appropriate detail and being an appropriate length also increased from 0% to 80%. The 9 attending pediatricians received maintenance of certification credits for their participation. CONCLUSIONS: A multifaceted quality improvement intervention, which included stakeholder involvement, clinician education, standardization of documentation, policy changes, and provision of board certification credits, improved the quality and timeliness of discharge summaries at our academic children's hospital.