Key result
A survey of primary care clinicians identified hospital course, discharge diagnoses, medication reconciliation, and follow-up as the most important discharge summary categories (95.5% concordance).
Why the study?
Existing guidelines for discharge summaries rarely focus on prioritizing content most important to optimize transitions of care amidst increasingly fragmented patient care in the United States.
Cross-Sectional (n=2,184)
Yes
High-yield content such as hospital course, discharge diagnoses, medication reconciliation, and follow-up should be prioritized at the beginning of discharge summaries to optimize transitions of care.
May inform discharge summary templates for primary care; leaves open whether incorporating clinician priorities improves transitions or safety.
BACKGROUND: Patient care in the United States has become increasingly more fragmented, and the discharge summary serves as a critical tool for transmitting information on a patient's hospital admission to the primary care clinician. Some guidelines regarding how to write discharge summaries exist, but few are focused on prioritizing content that is most important to optimize a patient's transition of care. METHODS: We conducted a national survey across various medical primary care specialties, including trainees and advanced practice providers, to understand the priorities of primary care clinicians. We distributed the survey to 2184 clinicians affiliated with 8 large academic institutions. Our response rate was 21%. RESULTS: Hospital course, discharge diagnoses, medication reconciliation, and follow-up sections were ranked as the most important categories with a 95.5% concordance rate among surveyed institutions. The least important sections were contact numbers for inpatient clinicians, ancillary services, weight-bearing status, and wound care. Similar themes were also identified via consensus review of the free-texted comments, adding that discharge summary style was also important. Other identified barriers to high-quality transition of care are both the limited time primary care clinicians can spend reviewing discharge summaries and lack of adequate communication between hospitalists and the outpatient clinician. CONCLUSIONS: High-yield content should be presented at the beginning of the discharge summary and conveyed in a brief, succinct manner to ensure maximal utility of the document as a transition of care tool.
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Silver et al. (2020) conducted a cross-sectional in Transition of care (n=2,184). Discharge summary content prioritization was evaluated on Priorities of primary care clinicians regarding discharge summary content. A survey of primary care clinicians identified hospital course, discharge diagnoses, medication reconciliation, and follow-up as the most important discharge summary categories (95.5% concordance).
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