Hospital Discharge Template Improves Compliance With Quality Measures

Terry Hartnett

April 13, 2010

April 13, 2010 (Washington, DC) — Patients with congestive heart failure (CHF) have an increased risk for complications from comorbidities, particularly during the hospital discharge process. At Hospital Medicine 2010: Society of Hospital Medicine (SHM) Annual Meeting, investigators presented a hospital discharge template designed to improve discharge plan documentation and adherence to quality measures, and to reduce the patient's risk for postdischarge complications.

The task of writing discharge orders and discharge instructions and using automated medication ordering systems is up to hospital residents who receive little or no training or advice on how to make sure that every consideration is made. But a simple discharge template, designed by a hospitalist at Brigham and Women's Hospital in Boston, Massachusetts, given to residents as part of the development of an overall discharge module is making a difference in clinical practice.

Lead investigator Robert Boxer, MD, PhD, from Brigham and Women's Hospital, told Medscape Internal Medicine that the computerized physician order entry system has improved both the quality of care that CHF patients receive and the efficiency of the discharge process.

Dr. Boxer presented the findings of a study on the use of the discharge template here in a poster session.

The template helps house staff write more concise and complete discharge instructions, Dr. Boxer said. "We took residents right at the beginning of their rotation on both internal medicine and cardiology units so that we could have the greatest impact on their clinical practice," Dr. Boxer explained.

A medical education session covered key elements in hospital discharge for CHF patients and introduced the discharge template as a guide to improving documentation. After the educational component of the study was completed, Dr. Boxer and his colleagues conducted a chart review to identify patients with a diagnosis of CHF on admission to the hospital and/or during the hospital stay. The primary goal of the study was to have residents complete all of the appropriate elements in the discharge process using the template. Examples of the elements include daily weights, fluid restrictions, and sodium restrictions.

Residents' discharge practices for 60 patients who were discharged before education about the discharge template were reviewed and compared with residents' practices for 47 patients discharged after the implementation of the template.

Documentation of key elements rose from 61% before the education to 80% afterward. Documentation of a discharge summary increased from 61% to 72%.

"After we introduced the template, we found that close to 100% of the residents used it to improve the hospital discharge process," Dr. Boxer reported.

Danielle Scheurer, MD, physician spokesperson for SHM and a hospitalist at Brigham and Women's Hospital, said the discharge template is a concrete example of how to reduce variations in any hospital process.

"A major role of the hospitalist is to standardize what we do," Dr. Scheurer told Medscape Internal Medicine.

"A congestive heart failure diagnosis historically has a high readmission rate, so it's a great place to make quality improvements. We want to standardize what we do to improve outcomes for patients and reduce variations in care," said Dr. Scheurer.

Drs. Scheurer and Boxer agree that the template can be modified and used with other diagnoses. "We are developing a discharge module that will be required use for all physicians" at Brigham and Women's Hospital, said Dr. Boxer. "Documentation, including the template for discharge instructions and summaries, will be a part of this overall quality improvement effort," he said.

The study did not receive commercial support. Dr. Boxer and Dr. Scheurer have disclosed no relevant financial relationships.

Hospital Medicine 2010: Society of Hospital Medicine (SHM) Annual Meeting. Abstract 24. Presented April 9, 2010.