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BMJ Qual Saf. 2013 Sep;22(9):768-74. doi: 10.1136/bmjqs-2012-001671. Epub 2013 May 23.

The Housestaff Incentive Program: improving the timeliness and quality of discharge summaries by engaging residents in quality improvement.

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  • 1Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, CA 94143, USA.



Quality improvement has become increasingly important in the practice of medicine; however, engaging residents in meaningful projects within the demanding training environment remains challenging.


We conducted a year-long quality improvement project involving internal medicine residents at an academic medical centre. Resident champions designed and implemented a discharge summary improvement bundle, which employed an educational curriculum, an electronic discharge summary template, regular data feedback and a financial incentive. The timeliness and quality of discharge summaries were measured before and after the intervention. Residents and faculty were surveyed about their perceptions of the project; primary care providers were surveyed about their satisfaction with hospital provider communication.


With implementation of the bundle, the average time from patient discharge to completion of the discharge summary fell from 3.5 to 0.61 days (p<0.001). The percentage of summaries completed on the day of discharge rose from 38% to 83% (p<0.001) and this improvement was sustained for 6 months following the end of the project. The percentage of summaries that included all recommended elements increased from 5% to 88% (p<0.001). Primary care providers reported a lower likelihood of discharge summaries being unavailable at the time of outpatient follow-up (38% to 4%, p<0.001). Residents reported that the systems changes, more than the financial incentive, accounted for their behaviour change.


Our discharge summary improvement project provides an instructive example of how residents can lead clinically meaningful quality improvement projects.


Financial incentives; Graduate medical education; Information technology; Quality improvement; Transitions in care

[PubMed - indexed for MEDLINE]
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