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The Ideal Hospital Discharge Summary

A Survey of U.S. Physicians

Sorita, Atsushi MD, MPH*; Robelia, Paul M. MD; Kattel, Sharma B. MD; McCoy, Christopher P. MD*; Keller, Allan Scott MD*; Almasri, Jehad MD§; Murad, Mohammad Hassan MD, MPH; Newman, James S. MD*; Kashiwagi, Deanne T. MD*

doi: 10.1097/PTS.0000000000000421
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Background Hospital discharge summaries enable communication between inpatient and outpatient physicians. Despite existing guidelines for discharge summaries, they are frequently suboptimal.

Objective The aim of this study was to assess physicians' perspectives about discharge summaries and the differences between summaries' authors (hospitalists) and readers (primary care physicians [PCPs]).

Methods A national survey of 1600 U.S. physicians was undertaken. Primary measures included physicians' preferences in discharge summary standardization, content, format, and audience.

Results A total of 815 physicians responded (response rate = 51%). Eighty-nine percent agreed that discharge summaries “should have a standardized format.” Most agreed that summaries should “document everything that was done, found, and recommended in the hospital” (64%) yet “only include details that are highly pertinent to the hospitalization” (66%). Although 74% perceived patients as an important audience of discharge summaries, only 43% agreed that summaries “should be written in language that patients…can easily understand,” and 68% agreed that it “should be written solely for provider-to-provider communication.” Compared with hospitalists, PCPs preferred comprehensive summaries (68% versus 59%, P = 0.002). More PCPs agreed that separate summaries should be created for patients and for provider-to-provider communication than hospitalists (60% versus 47%, P < 0.001). Compared with PCPs, more hospitalists believe that “hospitalists are too busy to prepare a high-quality discharge summary” (44% versus 23%, P < 0.001) and “PCPs have insufficient time to read an entire discharge summary” (60% versus 38%, P < 0.001).

Conclusions Physicians believe that discharge summaries should have a standardized format but do not agree on how comprehensive or in what format they should be. Efforts are necessary to build consensus toward the ideal discharge summary.

From the *Division of Hospital Internal Medicine, †Department of Family Medicine, Mayo Clinic; ‡Department of Hospital Medicine, Mayo Clinic Health System, Albert Lea; §Division of Health Care Policy and Research, Department of Health Sciences Research, and ∥Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota.

Correspondence: Deanne T. Kashiwagi, MD, Division of Hospital Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: kashiwagi.deanne@mayo.edu).

The authors disclose no conflict of interest.

The study was funded by Mayo Clinic. The funding source provided logistical and analytics support such as receiving the completed survey, entering data, and conducting statistical analyses. It did not have any roles in the study's design and reporting.

All authors substantially contributed to the conception or design of the study, data collection, or data analysis; wrote or reviewed the manuscript; and approved the final manuscript.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.journalpatientsafety.com).

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