Patient-centered discharge summaries to support safety and individual health literacy: a double-blind randomized controlled trial in Austria.

BACKGROUND: To ensure a safe patient discharge from hospital it is necessary to transfer all relevant information in a discharge summary (DS). The aim of this study was to evaluate a bundle of measures to improve the DS for physicians, nurses and patients. METHODS: In a double-blind, randomized, controlled trial, four different versions of DS (2 original, 2 revised) were tested with physicians, nurses and patients. We used an evaluation sheet (Case report form, CRF) with a 6-point Likert scale (1 = completely agree; 6 = strongly disagree). RESULTS: In total, 441 participants (physicians n = 146, nurses n = 140, patients n = 155) were included in the study. Overall, the two revised DS received significant better ratings than the original DS (original 2.8 ± 0.8 vs. revised 2.1 ± 0.9, p < 0.001). Detailed results for the main domains are structured DS (original 1.9 ± 0.9 vs. revised 2.2 ± 1.3, p = 0.015), content (original 2.7 ± 0.9 vs revised 2.0 ± 0.9, p < 0.001) and comprehensibility (original 3.8 ± 1.2vs. revised 2.3 ± 1.2, p < 0.001). CONCLUSION: With simple measures like avoiding abbreviations and describing indications or therapies with fixed contents, the DS can be significantly improved for physicians, nurses and patients at the same time. TRIAL REGISTRATION: First registration 13/11/2020 NCT04628728 at www. CLINICALTRIALS: gov , Update 15/03/2023.

Facilitating better postnatal care with women-held documents in The Gambia: a mixed-methods study.

BACKGROUND: Women-held documents are a basic component of continuity of maternity care. The use and completion of women-held documents following discharge could improve treatment and care for postnatal women. Using a mixed-methods study design, we aimed to assess the number, type, quality and completeness of women-held discharge documents, identify factors contributing to document completeness and facilitators or barriers for effective use of the documents. METHODS: Documents given to women at discharge from three hospitals in the Greater Banjul Area, The Gambia, were reviewed for content and quality. All women completed a questionnaire on the use of the documents. Poisson regression was used to estimate factors predicting document completion. Semi-structured interviews (n = 21) and focus groups (n = 2) were carried out with healthcare professionals (HCPs). RESULTS: Nearly all (n = 211/212; 99%) women were given a document to take home. The most complete document (maternal record) had on average 17/26 (65%) items completed and 10% of women held an illegible document. None of the women's sociodemographic or clinical characteristics predicted document completeness. The following facilitators for effective use of documents were identified from the women's responses to the questionnaire and interviews with HCPs: 94% of women thought written information is important, 99% plan to have postnatal check-ups and 67% plan to use their documents, HCPs understand the importance of the documents and were familiar with the document's use and content. The following barriers for effective use of documents were identified: HCPs had too many women-held documents to complete at discharge, there is no national protocol and HCPs think women do not understand the documents due to a lack of education and that women often lose or forget their documents. CONCLUSIONS: Women-held documents are well established in The Gambia; though quality and completeness needs improving. Future research should determine the impact of using only one document at discharge, protocols and training on completeness, among other outcomes, and on ways to ensure all women are using the documents for their postnatal care.

The Utility of the Modified Dionne's Egress Test as a Predictor of Falls in Adult Medical and Surgical Patients.

OBJECTIVE: The aim of this study was to compare the efficacy of a modified Dionne's Egress Test (Egress) as a predictor of falls with the Morse Fall Scale (MFS) in adult medical and surgical patients in an acute care setting. BACKGROUND: Nurses must identify fall risk while balancing fall prevention and early mobility in their care delivery. Fall risk screening tools alone are not enough to assist nurses in predicting patients at risk of falling. METHODS: A retrospective observational study design was used to compare the Egress as a predictor of falls to the MFS. The sample included data abstracted from 197 electronic health records and internal falls data. RESULTS: The Egress and the MFS are moderately and negatively correlated; however, only Egress was a significant predictor of falls. Passing the Egress, not being on benzodiazepines, and having a longer length of stay (LOS) results were associated with being less likely to fall. CONCLUSION: Egress is a better predictor of falls than MFS when benzodiazepines and LOS are controlled in the model.

Patients' and health professionals' perceptions of the LoDED (limit of detection and ECG discharge) strategy for low-risk chest pain management: a qualitative study.

BACKGROUND: Rapid discharge strategies for patients with low-risk chest pain using high-sensitivity troponin assays have been extensively evaluated. The adherence to, and acceptability of such strategies, has largely been explored using quantitative data. The aims of this integrated qualitative study were to explore the acceptability of the limit of detection and ECG discharge strategy (LoDED) to patients and health professionals, and to refine a discharge information leaflet for patients with low-risk chest pain. METHODS: Patients with low-risk chest pain who consented to a semi-structured interview were purposively sampled for maximum variation from four of the participating National Health Service sites between October 2018 and May 2019. Two focus groups with ED health professionals at two of the participating sites were completed in April and June 2019. RESULTS: A discharge strategy based on a single undetectable hs-cTn test (LoDED) was acceptable to patients. They trusted the health professionals who were treating them and felt reassured by other tests, (ECG) alongside blood test(s), even when the clinical assessment did not provide a firm diagnosis. In contrast, health professionals had reservations about the LoDED strategy, including concern about identifying low-risk patients and a shortened patient observation period. Findings from 11 patient interviews and 2 staff focus groups (with 20 clinicians) centred around three overarching themes: acceptability of the LoDED strategy, perceptions of symptom severity and uncertainty, and patient discharge information. CONCLUSION: Rapid discharge for low-risk chest pain is acceptable to patients, but clinicians reported some reticence in implementing the LoDED strategy. Further work is required to optimise discharge discussions and information provision for patients.

Estimating the obstetric co-morbidity burden using administrative data: The impact of the pregnancy-related assessment window.

BACKGROUND: Despite increased research using large administrative databases to identify determinants of maternal morbidity and mortality, the extent to which these databases capture obstetric co-morbidities is unknown. OBJECTIVE: To evaluate the impact that the time window used to assess obstetric co-morbidities has on the completeness of ascertainment of those co-morbidities. METHODS: We conducted a five-year analysis of inpatient hospitalisations of pregnant women from 2010-2014 using the Nationwide Readmissions Database. For each woman, using discharge diagnoses, we identified 24 conditions used to create the Obstetric Comorbidity Index. Using various assessment windows for capturing obstetric co-morbidities, including the delivery hospitalisation only and all weekly windows from 7 to 280 days, we calculated the frequency and rate of each co-morbidity and the degree of underascertainment of the co-morbidity. Under each scenario, and for each co-morbidity, we also calculated the all-cause, 30-day readmission rate. RESULTS: There were over 3 million delivery hospitalisations from 2010 to 2014 included in this analysis. Compared with a full 280-day window, assessment of obstetric co-morbidities using only diagnoses made during the delivery hospitalisation would result in failing to identify over 35% of cases of chronic renal disease, 28.5% cases in which alcohol abuse was documented during pregnancy, and 23.1% of women with pulmonary hypertension. For seven other co-morbidities, at least 1 in 20 women with that condition would have been missed with exclusive reliance on the delivery hospitalisation for co-morbidity diagnoses. Not only would reliance on delivery hospitalisations have resulted in missed cases of co-morbidities, but for many conditions, estimates of readmission rates for women with obstetric co-morbidities would have been underestimated. CONCLUSIONS: An increasing proportion of maternal and child health research is based on large administrative databases. This study provides data that facilitate the assessment of the degree to which important obstetric co-morbidities may be underascertained when using these databases.

Stroke Patients' Status Post-Acute Phase of Illness. How Is It and How Ought It to Be: Ain Shams University Experience.

BACKGROUND: Stroke is a leading cause of disability worldwide with a great impact on quality of life. Ain Shams University Hospital is a tertiary center for neurology and a pioneer in offering comprehensive stroke service in the region. METHODS: A cross sectional study in which an 8 domains questionnaire was applied to all cerebrovascular stroke patients who were admitted to the stroke unit of the neurology department of Ain Shams University Hospital in the period from January 2016 till May 2017, with the aim to define pitfalls in post discharge. RESULTS: From our study show that 20% of all patients discharged from acute stroke unit did not have further follow up with any stroke doctor. Moreover, 60% of patients were not seen by a physiotherapist after discharge, including almost half of patients with moderate or severe disability on discharge who are expected to have ongoing care needs. Patients who developed stroke complications were more likely to seek follow up. As expected, continuous follow up was associated with increased adherence to secondary preventive medications. CONCLUSIONS: Patient needs should be assessed before patient discharge and patient and care givers should have clear written information on required follow up with stroke doctors, and arrangements made for receiving adequate rehabilitation post discharge.

Low proportion of unreported cervical treatments in the cancer registry of Norway between 1998 and 2013.

BACKGROUND: Accurate information about treatment is needed to evaluate cervical cancer prevention efforts. We studied completeness and validity of reporting cervical treatments in the Cancer Registry of Norway (CRN). MATERIAL AND METHODS: We identified 47,423 (92%) high-grade cervical dysplasia patients with and 3983 (8%) without recorded treatment in the CRN in 1998-2013. We linked the latter group to the nationwide registry of hospital discharges in 1998-2015. Of patients still without treatment records, we randomly selected 375 for review of their medical history. Factors predicting incomplete treatment records were assessed by multiple imputation and logistic regression. RESULTS: Registry linkage revealed that 10% (401/3983) of patients received treatment, usually conization, within one year of their initial high-grade dysplasia diagnosis. Of those, 11% (n = 44) were missing due to unreporting and 89% (n = 357) due to misclassification at the CRN. Of all cases in medical review, patients under active surveillance contributed almost 60% (223/375). Other reasons of being without recorded treatment were uncertain dysplasia diagnosis, invasive cancer or death. Coding error occurred in 19% (73/375) of randomly selected cases. CRN undercounted receipt of treatment by 38% (n = 1526) among patients without recorded treatment which translates into 97% overall completeness of treatment data. Incomplete treatment records were particularly associated with public laboratories, patients aged 40-54 years, and the latest study years. CONCLUSIONS: CRN holds accurate information on cervical treatments. Completeness and particularly validity can be further improved through the establishment of new internal routines and regular linkage to hospital discharges.

Combining usability evaluations to highlight the chain that leads from usability flaws to usage problems and then negative outcomes.

Poor usability of health technology is thought to diminish work system performance, increase error rates and, potentially, harm patients. The present study (i) used a combination of usability evaluation methods to highlight the chain that leads from usability flaws to usage problems experienced by users and, ultimately, to negative patient outcomes, and (ii) validated this approach by studying two different discharge summary production systems. To comply with quality guidelines, the process of drafting and sending discharge summaries is increasingly being automated. However, the usability of these systems may modify their impact (or the absence thereof) in terms of production times and quality, and must therefore be evaluated. Here, we applied three successive techniques for usability evaluation (heuristic evaluation, user testing and field observation) to two discharge summary production systems (underpinned by different technologies). The systems' main usability flaws led respectively to an increase in the time need to produce a discharge summary and the risk of patient misidentification. Our results are discussed with regard to the possibility of linking the usability flaws, usage problems and the negative outcomes by successively applying three methods for evaluating usability (heuristic evaluation, user testing and in situ observations) throughout the system development life cycle.

Impact of the implementation of electronic health records on the quality of discharge summaries and on the coding of hospitalization episodes.

OBJECTIVE: To determine whether the implementation and use of the electronic health records (EHR) modifies the quality, readability and/or the length of the discharge summaries (DS) and the average number of coded diagnosis and procedures per hospitalization episode. DESIGN: A pre-post-intervention descriptive study conducted between 2010 and 2014. SETTING: The 'Hospital Universitario 12 de Octubre' (H12O) of Madrid (Spain). A tertiary University Hospital of up to 1200 beds. INTERVENTION: Implementation and systematic use of the EHR. MAIN OUTCOME MEASURES: The quality, length and readability of the DS and the number of diagnosis and procedures codes by raw and risk-adjusted data. RESULTS: A total of 200 DS were included in the present work. After the implementation of the EHR the DS had better quality per formal requirements, although were longer and harder to read (P < 0.001). The average number of coded diagnoses and procedures was increased, 9.48 in the PRE-INT and 10.77 in the POST-INT, and the difference was statistically significant (P < 0.001) in both raw and risk-adjusted data. CONCLUSIONS: The implementation of EHR improves the formal quality of DS, although poor use of EHR functionalities might reduce its understandability. Having more clinical information immediately available due to EHR increases the number of diagnosis and procedure codes enhancing their utility for secondary uses.

Evaluation of discharge documentation after hospitalization for stroke patients discharged home in Australia: A cross-sectional, pilot study.

In this cross-sectional study, we evaluated the quality of discharge documentation for stroke patients discharged home. Participants were stroke patients discharged from a regional tertiary acute and rehabilitation hospital in Australia from 2014 to 2015. Compliance with expected discharge documentation and its relationship with readmission was measured using an audit instrument for stroke patients (n = 54), and a post-discharge survey of carers was conducted. There were deficits in the documentation of the mechanism of stroke (70%), functional assessments (58%), pending test results (39%), types of support services required after discharge (35%), and patient/carer meetings with the multi-disciplinary stroke team (20%). Readmission was associated with lower compliance scores for information provided to patients or their carer. The survey results suggested that carer burden was high for carers of stroke patients discharged home. Documentation of carer/family meetings with the stroke team, functional assessments, medications, and adequate support services needs to be improved. General practitioners and carers need this information, so that they can address the post-discharge needs of these vulnerable patients.

Retrospective Chart Analysis of Concussion Discharge Instructions in the Emergency Department.

BACKGROUND: Recognition and diagnosis of concussion is increasing, but current research shows these patients are discharged from the emergency department (ED) with a wide variability of recommendations and instructions. OBJECTIVE: To assess the adequacy of documentation of discharge instructions given to patients discharged from the ED with concussions. METHODS: This was a quality-improvement study conducted at a University-based Level I trauma center. A chart review was performed on all patients discharged with closed head injury or concussion over a 1-year period. Chi-squared measures of association and Fisher's exact test were used to compare the proportion of patients receiving discharge instructions (printed or documented in the chart as discussed by the physician). Multivariable logistic regression was used to assess the relationship between whether the concussion was sport-related in relation to our primary outcomes. RESULTS: There were 1855 charts that met inclusion criteria. The physician documented discussion of concussion discharge instructions in 41% (95% confidence interval [CI] 39.2-43.7) and printed instructions were given in 71% (95% CI 69.1-73.2). Physicians documented discussion of instructions more often for sport-related vs. non-sport-related concussion (58% vs. 39%, p = 0.008) with an odds ratio (OR) of 2.1 (95% CI 1.6-2.8). Discharge instructions were given more often for sport-related injuries than those without sport-related injuries (85% vs. 69%, p = 0.047), with an OR of 2.2 (95% CI 1.6-3.1). Children were more likely to have had physician-documented discussion of instructions (56%, 95% CI 52.3-59.1 vs. 31%, 95% CI 28.0-33.6), printed discharge instructions (86%, 95% CI 83.2-88.1 vs. 61%, 95% CI 57.6-63.4), and return-to-play precautions given (11.2%, 95% CI 9.2-13.6 vs. 4.5%, 95% CI 3.4-5.9) compared with adults. CONCLUSIONS: Documentation of discharge instructions given to ED patients with concussions was inadequate, overall.

The Impact of Teach-Back Method on Retention of Key Domains of Emergency Department Discharge Instructions.

BACKGROUND: Studies have shown that patient understanding and recall of their emergency department (ED) discharge instructions is limited. The teach-back method involves patients repeating back what they understand, in their own words, so that discharge providers can confirm comprehension and correct misunderstandings. OBJECTIVE: The objective of this study was to determine if the teach-back method would increase retention of post ED discharge instructions. METHODS: A before-and-after study design (pre and post teach-back method) was used at an academic Midwestern institution. After discharge, patients were asked a set of standardized questions regarding their discharge instructions via telephone interview. Answers were compared with the participant's discharge instructions in the electronic medical record. A composite score measuring mean percent recall correct was calculated in four categories: diagnosis, medication reconciliation, follow-up instructions, and return precautions. Data were collected for 1 week prior to and 1 week post intervention. One additional week between the pre- and postintervention phases included training and practice behavior adoption. The primary outcome was mean percent recall correct between the two groups assessed by a Mann-Whitney U test, and adjusted for confounders with an analysis of covariance model. RESULTS: The mean percent recall correct in the teach-back phase was 79.4%, or 15 percentage points higher than the preintervention group. After adjusting for age and education, the adjusted model showed a recall rate of 70.0% pre vs. 82.1% (p < 0.005) post intervention. CONCLUSIONS: The teach-back method had a positive association on retention of discharge instructions in the ED regardless of age and education.

An Australian discharge summary quality assessment tool: A pilot study.

BACKGROUND: Patients' transition from hospital care to their general practitioner (GP) can put them at risk of unforeseen adverse events, which can be minimised by the GP receiving timely access to hospital discharge summaries. The objective of this article was to develop and pilot a discharge summary assessment tool, inclusive of components that Australian GPs identified as being most important for the safe transfer of care. METHODS: Development of the instrument was informed by a literature review pertaining to key components of effective discharge summaries. These components were included in a survey instrument, which was piloted by Australian GP participants. RESULTS: From 118 responses, the five highest ranked components of a discharge summary included lists of medications on discharge, diagnoses on discharge, reasons for any changes in medications, and details of follow-up arrangements and treatment in hospital. DISCUSSION: This paper describes the initial development and results of piloting an Australian discharge summary quality assessment tool.

[Proposal of standardised and logical templates for discharge letters and discharge summaries sent to general practitioners]. / Proposition d'un contenu standardisé et raisonné pour les lettres de liaison et les comptes-rendus d'hospitalisation à destination du médecin traitant.

Background: Communication between general practitioners (GPs) and hospitals is a weak point of the French health system. Unfortunately, hospital discharge documents, a keypoint for healthcare safety and efficiency, tend to be poorly defined. This study aimed to propose standardised and logical templates for discharge letters (DL) and discharge summaries (DS) with particular attention to GPs' needs.Methods: A Delphi methodology was conducted on the findings of a systematic review of the international literature. We recruited 28 experts including producers (hospital physicians and interns), recipients (GPs, head of the medical information department, patient representatives), and other professionals using discharge documents (representative of regional health administration for inspection and control, jurist, pharmacists).Results: A consensus was reached after two rounds of consultation. According to the experts, DS should ideally be available on the last day of hospitalization, but this is rarely possible. DL have therefore become the most important document for GPs. Two standardised and logical templates were submitted to the experts for validation. The templates were considered to be pertinent by the experts and were perceived as improving several key points such as writing and reading speed, communication between hospitals and community practitioners or safety of healthcare after discharge from hospital.Conclusion: DL and DS templates will be tested in pilot hospitals by an impact study.

Optimizing Transitions of Care - Hospital to Community.

Discharging patients from the hospital is a complex process, and preventing avoidable readmissions has the potential to improve both the quality of life for patients and the financial sustainability of the healthcare system (Alper et al. 2016). Improving the discharge process is one method to mitigate readmission to the hospital. Historically, St. Thomas Elgin General Hospital (STEGH) consistently experienced higher-than-expected readmission rates, and only 41% of discharge summaries were sent from the hospital to the community primary care within 48 hours. In addition, the overall percentage of patients attending a follow-up appointment with a primary care physician within seven days of discharge from hospital was lower than the provincial average. Through engagement with primary care providers (PCPs) and clinical associates (CAs) and with the use of standard work and monitoring organizational metrics, STEGH has achieved significant improvements.

Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study).

BACKGROUND: Medication related harm (MRH) is a common cause of morbidity and hospital admission in the elderly, and has significant cost implications for both primary and secondary healthcare resources. The development of risk prediction models has become an increasingly common phenomenon in medicine and can be useful to guide objective clinical decision making, resource allocation and intervention. There are no risk prediction models that are widely used in clinical practice to identify elderly patients at high risk of MRH following hospital discharge. The aim of this study is to develop a risk prediction model (RPM) to identify elderly patients at high risk of MRH upon discharge from hospital, and to compare this with routine clinical judgment. METHODS/DESIGN: This is a multi-centre, prospective observational study following a cohort of patients for 8 weeks after hospital discharge. Data collection including patient characteristics, medication use, social factors and frailty will take place prior to patient discharge and then the patient will be followed up in the community over the next 8 weeks to determine if they have experienced MRH. Research pharmacists will determine whether patients have experienced MRH by prospectively reviewing records for unplanned emergency department attendance, hospital readmission and GP consultation related to MRH. Research pharmacists will also telephone patients directly to determine self-reported MRH, which patients may not have sought further medical attention for. The data collected will inform the development of a RPM which will be externally validated in a follow-up study. DISCUSSION: There are no RPMs that are used in clinical practice to help stratify elderly patients at high risk of MRH in the community following hospital discharge, despite this being a significant public health problem. This study plans to develop a clinically useful RPM that is better than routine clinical judgment. As this is a multi-centre study involving clinical settings that serve elderly people of heterogeneous sociodemographic background, it is anticipated that this RPM will be generalizable.

Design of an orthopaedic-specific discharge summary.

BACKGROUND: Patients undergoing orthopaedic procedures experience major changes in function and daily routines upon their return home. Discharge summaries are an important communication tool that may play a role in optimizing a safe transition from hospital. Current care gaps and key elements of an ideal discharge summary specific for orthopaedic population are unknown. We sought to identify the challenges of current orthopaedic discharge summaries and to determine key elements of an ideal document. METHODS: Qualitative study survey using semi-structured interviews with a sample of 17 patients and clinicians representing diverse professions, backgrounds, and practice settings. We used the constant comparative method of qualitative analysis to define the experiences and perceptions of quality gaps and strategies to improve orthopaedic-specific discharge summaries. RESULTS: We identified 3 major themes describing factors perceived to be limiting the quality of current discharge summaries: 1) physician-centric documentation and the absence of a comprehensive, inter-professional perspective; 2) access to resources and health informatics; and 3) process variations in document creation and dissemination. CONCLUSIONS: Clinicians and patients identified several factors limiting the quality of discharge summaries among orthopaedic inpatients. Incorporating these elements could improve hospital transitions.

Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study.

BACKGROUND: Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. METHODS: We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians' scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014. RESULTS: The top three problems were incomplete reconciliation of medication during patient 'hand-overs', inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score. CONCLUSIONS: Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism.

Design and Hospitalwide Implementation of a Standardized Discharge Summary in an Electronic Health Record.

BACKGROUND: The hospital discharge summary is the primary method used to communicate a patient's plan of care to the next provider(s). Despite the existence of regulations and guidelines outlining the optimal content for the discharge summary and its importance in facilitating an effective transition to posthospital care, incomplete discharge summaries remain a common problem that may contribute to poor posthospital outcomes. Electronic health records (EHRs) are regularly used as a platform on which standardization of content and format can be implemented. The feasibility of designing and implementing a standardized discharge summary hospitalwide using an EHR was examined-to the authors' knowledge, for the first time. METHODS: This large-scale project at the University of Wisconsin Hospital and Clinics was led by a task force that had been assembled to develop best practices for EHR notes. The evidence-based Replicating Effective Programs (REP) model was employed to guide the development and implementation during the project. REP outlines four stages in clinical health service intervention implementation: preconditions, preimplementation, implementation, and maintenance. RESULTS: At 18 months postimplementation, 90% of all hospital discharge summaries were written using the standardized format. Hospital providers found the template helpful and easy to use, and recipient providers perceived an improvement in the quality of discharge summaries compared to those previously sent from the hospital. CONCLUSION: Discharge summaries can be standardized and implemented hospitalwide with both author and recipient provider satisfaction, particularly if evidence-based implementation strategies are employed. The use of EHR tools to guide clinicians in writing comprehensive discharge summaries holds promise in improving the existing deficits in communication at transitions of care.