Improving Timeliness in Surgical Discharge Summary Distribution: A Quality Improvement Initiative

Peng You; Jimmy Liu; Louise Moist; Kevin Fung; Julie E Strychowsky

doi:10.1177/2473974X221134106

Improving Timeliness in Surgical Discharge Summary Distribution: A Quality Improvement Initiative

OTO Open. 2022 Oct 25;6(4):2473974X221134106. doi: 10.1177/2473974X221134106. eCollection 2022 Oct-Dec.

Authors

Peng You¹, Jimmy Liu², Louise Moist³, Kevin Fung¹, Julie E Strychowsky¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada.
² London Health Sciences Centre Quality and Performance, London, Canada.
³ Department of Medicine, Schulich School of Medicine, Western University, London, Canada.

Abstract

Objective: To implement a quality improvement initiative to achieve an institutional targeted discharge summary distribution metric of 50% within 48 hours of patient discharge from hospital within an academic tertiary care otolaryngology-head and neck surgery department.

Methods: A pre- and postintervention study was conducted. Process mapping was performed. Interventions included education and engagement, implementation of auto-authentication (distribution immediately following transcription without review by the most responsible physician), and audit and feedback. The percentage of discharge summaries dictated with the auto-authentication code was evaluated. Process measures were collected for 12 months pre- and postimplementation. Balancing measures included workload and revisions to auto-authenticated notes. Analysis included summary statistics, statistical process control charting, and unpaired t tests.

Results: The mean ± SD percentage of discharge summaries distributed within 48 hours increased from 19% ± 6.4% preintervention to 54% ± 20% postintervention (P < .0001). Seventy-four percent of discharge summaries were dictated via the auto-authentication code. The target metric was met in 71% of discharges with the auto-authentication codes as compared with 26% with non-auto-authentication. The interventions did not result in any change to perceived workload, and the incidence of auto-authentication revisions was <1%. The results were sustained with an increase of 72% the following quarter. For fiscal year 2021-2022, performance remained sustained with an 85% completion rate.

Discussion: Our surgical department exceeded and sustained the targeted metric for timely discharge summary distribution using a quality improvement approach.

Implications for practice: Timely distribution of discharge summaries optimizes patients' transitions of care and can be achieved through stakeholder education and engagement, auto-authentication, and audit with feedback.

Keywords: PS/QI; discharge summaries; transitions of care.