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J Gen Intern Med. 2011 Jan;26(1):28-32. doi: 10.1007/s11606-010-1465-z. Epub 2010 Aug 10.

The effect of workload reduction on the quality of residents' discharge summaries.

Author information

1
Department of Medicine, Brigham and Women's Hospital, 221 Longwood Ave., RF-291, Boston, MA 02115, USA.

Abstract

BACKGROUND:

The completeness of hospital discharge summaries may reflect the overall quality of inter-professional communications. The effect of reducing resident workload on clinical performance is largely unknown.

OBJECTIVE:

We examined the impact of reducing housestaff workload on the quality of discharge summaries, an indicator of clinical performance, as compared to discharge summaries created by trainees on a team with a more typical workload.

DESIGN:

Patients admitted to a medicine service at a community teaching hospital affiliated with an academic medical center were alternately allocated between a control and intervention care team of residents. First-year residents on the intervention team carried an average census of 3.5 patients compared with 6.6 patients for peers on the control team. A random selection of 142 discharge summaries from a 3-month period were blindly evaluated using a structured tool based on professional documentation standards.

PARTICIPANTS:

61 internal medicine residents.

MAIN RESULTS:

Inter-rater reliability of discharge summary quality was 0.9. Discharge summaries produced by residents on the intervention team with a reduced workload had significantly more of the required elements (74 vs 65%, p<0.001). Intervention team summaries were more frequently complete and contained significantly more of the required elements describing the patient history (65.7% vs 36.1%, p=0.0005), the inpatient narrative (47.1% vs 22.2%, p=0.003), discharge planning (20.0% vs 5.5%, p=0.012), and continuity of care (24.3% vs 6.9%, p=0.005). Fewer than a quarter of the summaries reviewed included discharge instructions, information on follow-up care, or a discharge medication list.

CONCLUSIONS:

Reducing resident workload can significantly improve discharge summary quality, a measure of resident performance.

PMID:
20697967
PMCID:
PMC3024111
DOI:
10.1007/s11606-010-1465-z
[Indexed for MEDLINE]
Free PMC Article
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