Discharge Perfection: Assessing Documentation Quality at Mardan Medical Complex, Pakistan (2024 Audit Debut).

Background Patient discharge summaries not only play a vital role in ensuring continuity of care and patient safety but also serve as a communication tool between the primary and tertiary care settings. However, despite their paramount importance, most discharge summaries are either inaccurate or miss essential clinical information, posing considerable danger to patients. This clinical audit assesses the quality of discharge summaries at Mardan Medical Complex, Mardan, Pakistan, to identify areas for improvement. Aim The aim of this study is to assess the discharge summaries of patients at Mardan Medical Complex in Mardan, Pakistan, with a focus on their completeness, accuracy, and timeliness. Methods A cross-sectional, observational, and retrospective study was carried out in the Medical A ward of Mardan Medical Complex, Mardan, Pakistan, from September 2023 to October 2023. Out of the 897 discharge slips, a sample size of 105 participants was determined using Epi Info software. A systematic random sampling technique was used. Data was extracted from the hospital management information system and evaluated using a clinical audit tool based on standard guidelines from the Royal College of Physicians, Islamabad Healthcare Regulatory Authority, and Khyber Pakhtunkhwa Health Care Commission. To analyze the data, descriptive statistics were applied. Results The clinical audit revealed significant deficiencies in discharge summaries. Important patient demographics, such as contact details and safety alerts, were completely absent in 100% of the cases, and 48% of the summaries lacked the father's name. Admission details were similarly inadequate, with nearly all summaries missing critical information like admission time and reasons for admission. Clinical summaries and procedural details were absent in 73% and 87% of the cases, respectively. Discharge planning also showed major gaps, as special instructions according to the primary diagnosis and discharge destination were frequently neglected. Follow-up visits were recommended in only 71% of cases. Additionally, there were significant errors in in-home medication prescriptions, with 61% missing medication doses, 28% missing the route of administration, and 20% lacking the duration of treatment. Conclusions This clinical audit identified critical areas for improvement by revealing significant errors in the quality of discharge summaries at Mardan Medical Complex. It is recommended that standardized discharge slip templates be implemented, healthcare workers receive proper training, and thorough monitoring be conducted before patients are discharged. These measures aim to enhance the standard of documentation. Additionally, regular future clinical audits are essential for tracking the impact of these interventions and ensuring patient safety and continuity of care.

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.

Healthcare professionals' experiences of eHealth in palliative care for older people: challenges, compromises and the price of dignity.

PURPOSE: To explore whether and how eHealth solutions support the dignity of healthcare professionals and patients in palliative care contexts. METHOD: This qualitative study used phenomenographic analysis involving four focus group interviews, with healthcare professionals who provide palliative care to older people. RESULTS: Analysis revealed four categories of views on working with eHealth in hierarchical order: Safeguarding the patient by documenting-eHealth is a grain of support, Treated as less worthy by authorities-double standards, Distrust in the eHealth solution-when the "solution" presents a danger; and Patient first-personal contact with patients endows more dignity than eHealth. The ability to have up-to-date patient information was considered crucial when caring for vulnerable, dying patients. eHealth solutions were perceived as essential technological support, but also as unreliable, even dangerous, lacking patient information, with critical information potentially missing or overlooked. This caused distrust in eHealth, introduced unease at work, and challenged healthcare professionals' identities, leading to embodied discomfort and feeling of a lack of dignity. CONCLUSION: The healthcare professionals perceived work with eHealth solutions as challenging their sense of dignity, and therefore affecting their ability to provide dignified care for the patients. However, healthcare professionals managed to provide dignified palliative care by focusing on patient first.

CRABEL Score Assessment for Oral Surgery Excision Biopsy Case Notes of Oral Squamous Cell Carcinoma.

Background Oral surgical records contain all the information regarding a patient, including their history, clinical findings, diagnostic test results, pre-and postoperative care, progress, and medication. Notes that are properly drafted will help the physician argue that the course of therapy is appropriate. Several tools have been created for auditing clinical records; one such tool that may be used for any inpatient specialty is the CRABEL score system developed by CRAwford-BEresford-Lafferty. Aims This research aimed to evaluate the oral surgical records using the CRABEL scoring system for quality assessment. Materials and methods The case audit was performed from June 2023 to February 2024 for all Excisional biopsy cases of Oral Squamous Cell Carcinoma. Relevant data was retrieved from the Dental Information Archival Software (DIAS) of Saveetha Dental College and Hospitals, Chennai. It was evaluated by two independent oral pathologists trained in CRABEL scores. Two consecutive case records were evaluated. Fifty points were given for each case record. Scoring was given according to initial clerking (10 points), subsequent entries (30 points), consent (5 points), and discharge summary (5 points). The total score was calculated by subtracting the total deduction from 100 to give the final score. The mean scores of the case records were calculated. A descriptive statistical analysis was done with Statistical Package for Social Sciences (SPSS version 23.0; IBM Inc., Armonk, New York). Inter-observer agreement and reliability assessment were made using Kappa statistics.  Results From the DIAS in that period, the data of 52 cases were retrieved and reviewed. There was no proof of a reference source in the audited records, and one deduction was made to the reference score in the initial clerking, and the effective score was 98 out of 100. The mean values of 52 case records were also 98 out of 100. The observed kappa score was 1.0. There was no inter-observer bias in the scoring criteria. Both observers also gave the same scoring. Conclusion Our study illustrates that oral surgery case records in our institution were found to be accurate, as they maintained 98% of the CRABEL score value. Frequent audit cycles will help in standardizing and maintaining the quality of oral surgery case records.

Intervention for a correct medication list and medication use in older adults: a non-randomised feasibility study among inpatients and residents during care transitions.

BACKGROUND: Medication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient's medication use at home. AIM: In preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients, and data collection to reduce medication discrepancies at discharge and improve medication adherence, and (2) to explore the outcomes of the interventions. METHOD: Participants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed. RESULTS: Of 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores. CONCLUSION: Based on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.

Transforming healthcare documentation: harnessing the potential of AI to generate discharge summaries.

BACKGROUND: Hospital discharge summaries play an essential role in informing GPs of recent admissions to ensure excellent continuity of care and prevent adverse events; however, they are notoriously poorly written, time-consuming, and can result in delayed discharge. AIM: To evaluate the potential of artificial intelligence (AI) to produce high-quality discharge summaries equivalent to the level of a doctor who has completed the UK Foundation Programme. DESIGN & SETTING: Feasibility study using 25 mock patient vignettes. METHOD: Twenty-five mock patient vignettes were written by the authors. Five junior doctors wrote discharge summaries from the case vignettes (five each). The same case vignettes were input into ChatGPT. In total, 50 discharge summaries were generated; 25 by Al and 25 by junior doctors. Quality and suitability were determined through both independent GP evaluators and adherence to a minimum dataset. RESULTS: Of the 25 AI-written discharge summaries 100% were deemed by GPs to be of an acceptable quality compared with 92% of the junior doctor summaries. They both showed a mean compliance of 97% with the minimum dataset. In addition, the ability of GPs to determine if the summary was written by ChatGPT was poor, with only a 60% accuracy of detection. Similarly, when run through an AI-detection tool all were recognised as being very unlikely to be written by AI. CONCLUSION: AI has proven to produce discharge summaries of equivalent quality to a junior doctor who has completed the UK Foundation Programme; however, larger studies with real-world patient data with NHS-approved AI tools will need to be conducted.

Critérios relacionados à alta hospitalar segura do recém-nascido: Uma revisão integrativa

Objetivo: Identificar os principais critérios evidenciados pela literatura científica envolvidos na alta hospitalar segura do recém-nascido. Método: Trata-se de uma revisão integrativa da literatura, realizada em dezembro de 2021 nas bases de dados Pubmed/ Medline, BVS, Scopus, Lilacs, utilizando-se os descritores "patient discharge summaries" OR "patient discharge" AND "newborn". O estudo foi fundamentado pelos procedimentos metodológicos PRISMA, foram adotados critérios de elegibilidade, critérios de inclusão: artigos disponíveis na íntegra, publicados nos últimos 5 anos, nos idiomas inglês, espanhol e português que versassem sobre cuidados ao recém-nascido, alta hospitalar ou alta do paciente neonatal. E de exclusão: todos os artigos que não atendiam ao objetivo da pesquisa e ou não possuíam relação com o tema em estudo. Resultados: Dos 94 artigos identificados entre 2017 e 2021 foram incluídos 12 estudos, sendo a maioria do Brasil e de abordagem qualitativa. Foram estabelecidas três categorias temáticas de análise: 1) Parâmetros biofisiológicos; 2) Comunicação e orientação aos pais: fragilidades e potencialidades da família; e 3) Cuidados pós alta e seguimento de rede. Conclusão: De acordo com a bibliografia selecionada está concluído que a alta hospitalar segura de recém-nascidos requer atenção aos aspectos fisiológicos, de comunicação com a família e intersetorial para seguimento de rede.

Objetivo: Identificar los principales criterios evidenciados por la literatura científica involucrados en el alta hospitalaria segura del recién nacido. Método: Revisión integrativa de la literatura, realizada en diciembre de 2021 en las bases de datos Pubmed/Medline, BVS, Scopus, Lilacs, utilizando los descriptores "patient high summaries" OR "patient high" AND "newborn". El estudio se basó en los procedimientos metodológicos PRISMA, se adoptaron criterios de elegibilidad y criterios de inclusión: artículos disponibles en su totalidad, publicados en los últimos 5 años, en inglés, español y portugués que versan sobre la atención del recién nacidos, el alta hospitalaria o el alta del paciente neonatal. Se excluyeron todos los artículos que no cumplieran con el objetivo de la investigación y/o no tuvieran relación con el tema en estudio. Resultados: De los 94 artículos identificados entre 2017 y 2021, se incluyeron 12 estudios, la mayoría de Brasil y con abordaje cualitativo. Se establecieron tres categorías temáticas de análisis: 1) Parámetros biofisiológicos 2) Comunicación y orientación a los padres: fragilidades y potencialidades de la familia y 3) Atención posterior al alta y seguimiento en red. Conclusión: Según a la bibliografía seleccionada, se concluye que el alta hospitalaria segura de los recién nacidos requiere atención a aspectos fisiológicos, de comunicación con la familia e intersectoriales para el seguimiento en red.

Objective: To identify the main criteria evidenced by the literature published on newborns' hospital discharge. Method: This is an integrative literature review, carried out in December 2021 in the PubMed/Medline, BVS, Scopus and LILACS databases, using the "patient discharge summaries" OR "patient discharge" AND "newborn" descriptors. The study was based on PRISMA methodological procedures, eligibility criteria were adopted, and the inclusion criteria were as follows: articles available in full, published in the last 5 years in English, Spanish and Portuguese and dealing with newborn care, hospital discharge or neonatal patient discharge. All articles that did not meet the research objective and/or were not related to the topic under study were excluded. Results: Of the 94 articles identified between 2017 and 2021, 12 studies were included, most from Brazil and with a qualitative approach. Three thematic analysis categories were established: 1) Biophysiological parameters; 2) Communication and guidelines for parents: weaknesses and strengths of the family; and 3) Post-discharge care: network follow-up. Conclusion: According to the selected bibliography, it is concluded that newborns' safe hospital discharge requires attention to the physiological, communication with the family and intersectoral aspects for network follow-up.

The Quality of Discharge Summaries After Acute Kidney Injury.

Background: Acute kidney injury (AKI) increases the risk of hospital readmission, chronic kidney disease, and death. Therefore, effective communication in discharge summaries is essential for safe transitions of care. Objective: The objectives of this study were to determine the quality of discharge summaries in AKI survivors and identify predictors of higher quality discharge summaries. Design: Retrospective chart review. Setting: Tertiary care academic center in Ontario, Canada. Patients: We examined the discharge summary quality of 300 randomly selected adult patients who survived a hospitalization with AKI at our tertiary care hospital, stratified by AKI severity. We included 150 patients each from 2015 to 2016 and 2018 to 2019, before and after introduction of a post-AKI clinic in 2017. Measurements: We reviewed charts for 9 elements of AKI care to create a composite score summarizing discharge summary quality. Methods: We used multivariable logistic regression to identify predictors of discharge summary quality. Results: The median discharge summary composite score was 4/9 (interquartile range, 2-6). The least frequently mentioned elements were baseline creatinine (n = 55, 18%), AKI-specific follow-up labs (n = 66, 22%), and medication recommendations (n = 80, 27%). The odds of having a higher quality discharge summary (composite score ≥4/9) was greater for every increase in baseline creatinine of 25 µmol/L (adjusted odds ratio [aOR]: 1.27; 95% confidence interval [CI]: 1.03, 1.56), intrarenal etiology (aOR: 2.32; 95% CI: 1.26, 4.27), and increased AKI severity (stage 2 aOR: 2.57; 95% CI: 1.35, 4.91 and stage 3 aOR: 3.36; 95% CI: 1.56, 7.22). There was no association between discharge summary quality and the years before and after introduction of a post-AKI clinic (aOR: 0.77; 95% CI: 0.46, 1.29). Limitations: The single-center study design limits generalizability. Conclusions: Most discharge summaries are missing key AKI elements, even in patients with severe AKI. These gaps suggest several opportunities exist to improve discharge summary communication following AKI.

Contexte: L'insuffisance rénale aiguë (IRA) augmente le risque de réadmission à l'hôpital, d'insuffisance rénale chronique et de décès. Une communication efficace est essentielle dans le résumé de départ pour assurer une transition sécuritaire des soins. Objectifs: Cette étude visait à évaluer la qualité des résumés de départ des survivants d'un épisode d'IRA et à identifier les facteurs prédictifs d'un résumé de départ de meilleure qualité. Conception: Examen rétrospectif des dossiers médicaux. Cadre: Un centre universitaire de soins tertiaires d'Ottawa (Ontario) au Canada. Sujets: Nous avons examiné la qualité du résumé de départ de 300 patients adultes ayant survécu à une hospitalisation pour IRA dans notre hôpital de soins tertiaires. Les patients ont été sélectionnés au hasard et stratifiés selon la gravité de l'IRA. Nous avons retenu 150 patients pour la période 2015-2016 et 150 patients pour la période 2018-2019; soit les périodes précédant et suivant l'introduction d'une clinique post-IRA en 2017. Mesures: Nous avons examiné les dossiers médicaux à la recherche de neuf éléments des soins d'IRA afin de créer un score composite évaluant la qualité du résumé de départ. Méthodologie: La régression logistique multivariée a été employée pour identifier les facteurs prédictifs de la qualité d'un résumé de départ. Résultats: Le score composite médian était de 4/9 (intervalle interquartile: 2-6). Les éléments les moins souvent mentionnés dans le résumé de départ étaient le taux de créatinine initial (n= 55; 18 %), les analyses de laboratoires liées spécifiquement au suivi de l'IRA (n= 66; 22 %) et les recommandations portant sur la médication (n= 80; 27 %). Les probabilités d'avoir un résumé de départ de qualité supérieure (score composite ≥4/9) étaient plus élevées pour chaque augmentation de 25 µmol/L de la créatinine initiale (RC corrigé [RCc] = 1,27; IC 95: 1,03-1,56), lorsque l'étiologie était intrarénale (RCc: 2,32; IC 95: 1,26-4,27) et la gravité de l'IRA accrue ([stade 2] RCc: 2,57; IC 95: 1,35-4,91; et [stade 3] RCc: 3,36; IC 95: 1,56-7,22). Aucune association n'a été observée entre la qualité du résumé de départ et la période étudiée, soit avant ou après l'introduction de la clinique post-IRA (RCc: 0,77; IC 95: 0,46-1,29). Limites: L'étude est monocentrique, ce qui limite la généralisabilité des résultats. Conclusion: Certains éléments clés des soins de l'IRA étaient absents de la plupart des résumés de départ, même chez les patients gravement atteints d'IRA. Ces lacunes indiquent qu'il est possible d'améliorer la communication du résumé de départ à la suite d'un épisode d'IRA.

Talking About Notes: Using a Design-Based Research Approach to Develop a Discharge Summary Template on a Geriatric Inpatient Unit.

Background: Discharge summaries are important educational tools, guiding trainees in their collection and documentation of data. As geriatric competencies are integrated in medical curricula, documentation on in-patient geriatric rotations should represent the unique care and education provided, yet often follow generic templates. What content should be included in a geriatric discharge summary has not previously been explored and was the purpose of this study. Methods: A mixed-methods, designed-based research approach was used to assess note quality on a geriatric in-patient unit and iteratively co-develop a template with examples through three phases: 1) needs assessment, 2) consensus building, and 3) template development. Results: Sixty-eight discharge summaries were assessed by five geriatricians, with 14 gaps identified. Many of these reflected elements that were present but addressed generically without attention to the specificity required from a geriatric perspective. In response, the team developed a geriatric-specific template with explicit examples. Through the consensus process three barriers to quality notes and trainee education were identified: the chronic state of low-quality notes being accepted as the norm, time limitations due to the high volume of patients, and high volume of clinical documents. Conclusions: The identification of gaps in geriatric discharge summaries allowed for the co-development of an instructional template and examples that goes beyond simple headings and highlights the importance of applying and documenting geriatric competencies. Although we encourage others to take up and modify the tools for trainees in their local context, more importantly, we encourage them to take up the dialogue about note quality.

Implementation of a Patient Summary Web Application According to the International Patient Summary and Validation in Common Use Cases in Japan.

BACKGROUND: The application of standardized patient summaries would reduce the risk of information overload and related problems for physicians and nurses. Although the International Patient Summary (IPS) standard has been developed, disseminating its applications has challenges, including data conversion of existing systems and development of application matching with common use cases in Japan. This study aimed to develop a patient summary application that summarizes and visualizes patient information accumulated by existing systems. METHODS: We converted clinical data from the Standardized Structured Medical Information eXchange version 2 (SS-MIX2) storage at Tohoku University Hospital into the Health Level 7 Fast Healthcare Interoperability Resource (FHIR) repository. Subsequently, we implemented a patient summary web application concerning the IPS and evaluated 12 common use cases of the discharge summary. RESULTS: The FHIR resources of seven of the necessary IPS sections were successfully converted from existing SS-MIX2 data. In the main view of the application we developed, all the minimum necessary patient information was summarized and visualized. All types of mandatory or required sections in the IPS and all structured information items of the discharge summary were displayed. Of the discharge summary, 75% of sections and 61.7% of information items were completely displayed, matching 12 common use cases in Japan. CONCLUSIONS: We implemented a patient summary application that summarizes and visualizes patient information accumulated by existing systems and is evaluated in common use cases in Japan. Efficient sharing of the minimum necessary patient information for physicians is expected to reduce information overload, workload, and burnout.

The Quality of Discharge Summaries at Al-Shaab Hospital, Sudan, in 2022: The First Cycle of a Clinical Audit.

Background The discharge summary is a vital component of the modern health system. It is defined as a synopsis of information regarding events occurring during the inpatient care of a patient, to allow for a safe, quick, and effective patient-centered discharge process. It contains important information about the patient's hospital stay, including the reason for admission, treatment received, and follow-up needed. Low-quality discharge summaries pose a great risk to patient healthcare since the most frequent reason for error in clinical settings is poor communication. In the United Kingdom, the Professional Record Standards Body (PRSB) has adopted the Academy of Medical Royal Colleges (AoMRC) "Standards for the Clinical Structure and Content of Patient Records" and produced a standard discharge summary form. This study aimed to assess the quality of discharge summaries at Al-Shaab Hospital in Sudan in terms of information, filling adequacy, and adherence to international guidelines and evaluate the discharge interviews. Methods A cross-sectional institution-based study was conducted in the period of September to December 2022 at Al-Shaab Teaching Hospital in Khartoum, Sudan. Systematic random sampling was used to select the study participants from the discharged patients. A total of 70 patients were met in their wards over a period of two months, and the contents of their discharge cards were compared to items on an online checklist based on the Professional Record Standards Body (PRSB) and the Academy of Medical Royal Colleges (AoMRC) standard discharge summary. The patients were also interviewed to assess their knowledge regarding their discharge information. Results The hospital's discharge summary form contained only four headings: date, patient name, age, and ID number. The assessed cards were found to be missing valuable information, including date of admission (missing in 83%), filling doctor's name (missing in 71%), and medication changes (missing in 70%). Only half of the summaries were clearly readable. The majority of patients had poor knowledge regarding their medication side effects (89%) and how to act in an emergency (86%), while knowledge of medication doses and follow-up details was good in 80% and 66%, respectively. Conclusion The patients are discharged with inadequately filled discharge forms. This may be due to the poor design of the form, so a newly designed form will be proposed, based on international standards. The discharge interview is also in need of improvement, to make sure patients are fully aware of their condition.

Evaluating the Usability of an Emergency Department After Visit Summary: Staged Heuristic Evaluation.

BACKGROUND: Heuristic evaluations, while commonly used, may inadequately capture the severity of identified usability issues. In the domain of health care, usability issues can pose different levels of risk to patients. Incorporating diverse expertise (eg, clinical and patient) in the heuristic evaluation process can help assess and address potential negative impacts on patient safety that may otherwise go unnoticed. One document that should be highly usable for patients-with the potential to prevent adverse outcomes-is the after visit summary (AVS). The AVS is the document given to a patient upon discharge from the emergency department (ED), which contains instructions on how to manage symptoms, medications, and follow-up care. OBJECTIVE: This study aims to assess a multistage method for integrating diverse expertise (ie, clinical, an older adult care partner, and health IT) with human factors engineering (HFE) expertise in the usability evaluation of the patient-facing ED AVS. METHODS: We conducted a three-staged heuristic evaluation of an ED AVS using heuristics developed for use in evaluating patient-facing documentation. In stage 1, HFE experts reviewed the AVS to identify usability issues. In stage 2, 6 experts of varying expertise (ie, emergency medicine physicians, ED nurses, geriatricians, transitional care nurses, and an older adult care partner) rated each previously identified usability issue on its potential impact on patient comprehension and patient safety. Finally, in stage 3, an IT expert reviewed each usability issue to identify the likelihood of successfully addressing the issue. RESULTS: In stage 1, we identified 60 usability issues that violated a total of 108 heuristics. In stage 2, 18 additional usability issues that violated 27 heuristics were identified by the study experts. Impact ratings ranged from all experts rating the issue as "no impact" to 5 out of 6 experts rating the issue as having a "large negative impact." On average, the older adult care partner representative rated usability issues as being more significant more of the time. In stage 3, 31 usability issues were rated by an IT professional as "impossible to address," 21 as "maybe," and 24 as "can be addressed." CONCLUSIONS: Integrating diverse expertise when evaluating usability is important when patient safety is at stake. The non-HFE experts, included in stage 2 of our evaluation, identified 23% (18/78) of all the usability issues and, depending on their expertise, rated those issues as having differing impacts on patient comprehension and safety. Our findings suggest that, to conduct a comprehensive heuristic evaluation, expertise from all the contexts in which the AVS is used must be considered. Combining those findings with ratings from an IT expert, usability issues can be strategically addressed through redesign. Thus, a 3-staged heuristic evaluation method offers a framework for integrating context-specific expertise efficiently, while providing practical insights to guide human-centered design.

Improving the accuracy of discharge medication documentation in people with kidney disease through pharmacist-led partnered prescribing.

BACKGROUND: Inaccurate medication documentation in prescriptions and discharge summaries produce poorer patient outcomes, are costly to healthcare systems and result in more readmissions to hospital. Errors in medication documentation are common in Australian hospitals. AIM: To determine whether pharmacist-led partnered prescribing (PPP) on discharge reduced errors and improved accuracy in documentation of medications in the discharge prescription and the discharge summary of people with kidney disease compared with medical prescribing (MP). METHODS: This interventional two-phase study compared current workflow (MP) with the subsequent implementation of the interventional workflow (PPP) in the renal unit of a tertiary referral hospital. Patients were included if they were discharged within pharmacy working hours and had a discharge prescription and discharge summary. The primary outcome was the percentage of discharge prescriptions with at least one error. The secondary outcome was the percentage of discharge summaries with at least one error. RESULTS: Data were collected from 185 discharged patients (95 in MP phase then 90 in PPP phase). Discharge prescriptions with at least one error reduced from 75.8% in the MP phase to 6.7% in PPP phase (P < 0.001). Discharge summaries with at least one error reduced from 53% in MP phase to 24% in the PPP phase (P < 0.001). CONCLUSION: PPP improves the accuracy of the documentation of medications in both the discharge prescription and the discharge summary of patients with kidney disease.

Prevalence and Risk Factors for Dangerous Abbreviations in Malaysian Electronic Clinical Notes.

Medical abbreviations can be misinterpreted and endanger patients' lives. This research is the first to investigate the prevalence of abbreviations in Malaysian electronic discharge summaries, where English is widely used, and elicit the risk factors associated with dangerous abbreviations. We randomly sampled and manually annotated 1102 electronic discharge summaries for abbreviations and their senses. Three medical doctors assigned a danger level to ambiguous abbreviations based on their potential to cause patient harm if misinterpreted. The predictors for dangerous abbreviations were determined using binary logistic regression. Abbreviations accounted for 19% (33,824) of total words; 22.6% (7640) of those abbreviations were ambiguous; and 52.3% (115) of the ambiguous abbreviations were labelled dangerous. Increased risk of danger occurs when abbreviations have more than two senses (OR = 2.991; 95% CI 1.586, 5.641), they are medication-related (OR = 6.240; 95% CI 2.674, 14.558), they are disorders (OR = 7.771; 95% CI 2.054, 29.409) and procedures (OR = 3.492; 95% CI 1.376, 8.860). Reduced risk of danger occurs when abbreviations are confined to a single discipline (OR = 0.519; 95% CI 0.278, 0.967). Managing abbreviations through awareness and implementing automated abbreviation detection and expansion would improve the quality of clinical documentation, patient safety, and the information extracted for secondary purposes.

Assessing the Racial and Socioeconomic Disparities in Postpartum Depression Using Population-Level Hospital Discharge Data: Longitudinal Retrospective Study.

BACKGROUND: In the United States, >3.6 million deliveries occur annually. Among them, up to 20% (approximately 700,000) of women experience postpartum depression (PPD) according to the Centers for Disease Control and Prevention. Absence of accurate reporting and diagnosis has made phenotyping of patients with PPD difficult. Existing literature has shown that factors such as race, socioeconomic status, and history of substance abuse are associated with the differential risks of PPD. However, limited research has considered differential temporal associations with the outcome. OBJECTIVE: This study aimed to estimate the disparities in the risk of PPD and time to diagnosis for patients of different racial and socioeconomic backgrounds. METHODS: This is a longitudinal retrospective study using the statewide hospital discharge data from Maryland. We identified 160,066 individuals who had a hospital delivery from 2017 to 2019. We applied logistic regression and Cox regression to study the risk of PPD across racial and socioeconomic strata. Multinomial regression was used to estimate the risk of PPD at different postpartum stages. RESULTS: The cumulative incidence of PPD diagnosis was highest for White patients (8779/65,028, 13.5%) and lowest for Asian and Pacific Islander patients (248/10,760, 2.3%). Compared with White patients, PPD diagnosis was less likely to occur for Black patients (odds ratio [OR] 0.31, 95% CI 0.30-0.33), Asian or Pacific Islander patients (OR 0.17, 95% CI 0.15-0.19), and Hispanic patients (OR 0.21, 95% CI 0.19-0.22). Similar findings were observed from the Cox regression analysis. Multinomial regression showed that compared with White patients, Black patients (relative risk 2.12, 95% CI 1.73-2.60) and Asian and Pacific Islander patients (relative risk 2.48, 95% CI 1.46-4.21) were more likely to be diagnosed with PPD after 8 weeks of delivery. CONCLUSIONS: Compared with White patients, PPD diagnosis is less likely to occur in individuals of other races. We found disparate timing in PPD diagnosis across different racial groups and socioeconomic backgrounds. Our findings serve to enhance intervention strategies and policies for phenotyping patients at the highest risk of PPD and to highlight needs in data quality to support future work on racial disparities in PPD.

Development and pilot implementation of a patient-oriented discharge summary for critically Ill patients.

BACKGROUND: Patients leaving the intensive care unit (ICU) often experience gaps in care due to deficiencies in discharge communication, leaving them vulnerable to increased stress, adverse events, readmission to ICU, and death. To facilitate discharge communication, written summaries have been implemented to provide patients and their families with information on medications, activity and diet restrictions, follow-up appointments, symptoms to expect, and who to call if there are questions. While written discharge summaries for patients and their families are utilized frequently in surgical, rehabilitation, and pediatric settings, few have been utilized in ICU settings. AIM: To develop an ICU specific patient-oriented discharge summary tool (PODS-ICU), and pilot test the tool to determine acceptability and feasibility. METHODS: Patient-partners (i.e., individuals with lived experience as an ICU patient or family member of an ICU patient), ICU clinicians (i.e., physicians, nurses), and researchers met to discuss ICU patients' specific informational needs and design the PODS-ICU through several cycles of discussion and iterative revisions. Research team nurses piloted the PODS-ICU with patient and family participants in two ICUs in Calgary, Canada. Follow-up surveys on the PODS-ICU and its impact on discharge were administered to patients, family participants, and ICU nurses. RESULTS: Most participants felt that their discharge from the ICU was good or better (n = 13; 87.0%), and some (n = 9; 60.0%) participants reported a good understanding of why the patient was in ICU. Most participants (n = 12; 80.0%) reported that they understood ICU events and impacts on the patient's health. While many patients and family participants indicated the PODS-ICU was informative and useful, ICU nurses reported that the PODS-ICU was "not reasonable" in their daily clinical workflow due to "time constraint". CONCLUSION: The PODS-ICU tool provides patients and their families with essential information as they discharge from the ICU. This tool has the potential to engage and empower patients and their families in ensuring continuity of care beyond ICU discharge. However, the PODS-ICU requires pairing with earlier discharge practices and integration with electronic clinical information systems to fit better into the clinical workflow for ICU nurses. Further refinement and testing of the PODS-ICU tool in diverse critical care settings is needed to better assess its feasibility and its effects on patient health outcomes.

Proactive care post-discharge to reduce 30 day readmissions to hospital.

BACKGROUND: Healthwatch England estimated emergency readmissions have risen by 22.8% between 2012-13 and 2016-17. Some emergency readmissions could be avoided by providing patients with urgent out of hospital medical care or support. Sovereign Health Network (SHN) comprises of three GP practices, with a combined population of 38,000. OBJECTIVE: We will decrease the number of SHN patients readmitted within 30 days of discharge from Portsmouth Hospitals Trust following a non-elective admission (excluding Emergency Department attendance) by 40-60% by July 2020. METHODS: Four Plan, Do, Study, Act (PDSA) cycles were used to test the administrative and clinical processes. Our Advanced Nurse Practitioner reviewed all discharge summaries, added alerts to records, and proactively contacted patients either by text, telephone or home visit. RESULTS: 92 patients aged 23 days to 97 years were admitted onto the recent discharge scheme. Half of discharge summaries were received on the day of discharge, whilst 29% of discharge summaries were received more than 24 hours post-discharge, and one was received 11 days post-discharge. Following our interventions, there were 55% less than expected readmissions during the same time period. CONCLUSION: To allow proactive interventions to be instigated in a timely manner, discharge summaries need to be received promptly. The average readmission length of stay following a non-elective admission is seven days. Our proactive interventions saved approximately 102.9 bed days, with potential savings of 1,775 bed days over a year. We feel the results from our model are promising and could be replicated by other Primary Care Networks to result in larger savings in bed days.

Improving the quality of inpatient discharge summaries.

BACKGROUND: Discharge summaries (DCS) are vital in facilitating handover to community colleagues. Unfortunately, at Whittington Health, General Practitioners (GPs) found it difficult to identify relevant information in DCS, and use of medical jargon meant patients did not understand details of their admission. With this quality improvement project, the team aimed to improve DCS to enhance patient-centered care. OBJECTIVE: The aim of this quality improvement project (QIP) was to improve the quality of DCS by critiquing the ones produced within our trust and implementing various interventions. METHODS: Multiple Plan-Do-Study-Act (PDSA) cycles were completed. A multi-disciplinary meeting was conducted to identify the needs of each party in a DCS. A new template was subsequently launched. Teaching was conducted and educational leaflets were disseminated hospital-wide. Quality of written communication was audited quarterly, and evaluated against quality indicators. Problems with DCS were identified via GP and patient feedback, and these became the focus of subsequent PDSA cycles. RESULTS: From March 2019 to February 2020, all the audited categories improved, with an overall improvement from 67% to 92%. We also received positive feedback from GPs. CONCLUSIONS: Quality of DCS can be improved with appropriate interventions, leading to improved patient care. A similar PDSA cycle could be utilized elsewhere to achieve similar results.

Written discharge communication of diagnostic and decision-making information for persons living with dementia during hospital to skilled nursing facility transitions.

Hospital-to-skilled nursing facility (SNF) transitions constitute a vulnerable point in care for people with dementia and often precede important care decisions. These decisions necessitate accurate diagnostic/decision-making information, including dementia diagnosis, power of attorney for health care (POAHC), and code status; however, inter-setting communication during hospital-to-SNF transitions is suboptimal. This retrospective cohort study examined omissions of diagnostic/decision-making information in written discharge communication during hospital-to-SNF transitions. Omission rates were 22% for dementia diagnosis, 82% and 88% for POAHC and POAHC activation respectively, and 70% for code status. Findings highlight the need to clarify and intervene upon causes of hospital-to-SNF communication gaps.

Comprehensive evaluation of using computerised provider order-entry system for hospital discharge orders.

BACKGROUND: Computerised prescriptions for Hospital Discharge Orders (HDO) are used world-wide to secure medication processes. OBJECTIVES: To evaluate physicians' adoption of computerised provider order-entry (CPOE) for HDO and the prescribing error rate of HDO in an acute medical care unit. SETTING: A prospective study was conducted in an internal medicine department over a six-month period. The use rate of CPOE for HDO edition, prescription lines concordance between CPOE-edited HDO, exit prescriptions transcribed in the discharge summary (DS), and prescribing error rate in CPOE-edited HDO were all evaluated. RESULTS: A total of 407 patients with HDO were included in the study. HDO were edited via CPOE system for 350 patients (86%), among which 124 (35%) were identically transcribed, 217 (62%) had discrepancies, and nine (3%) were not transcribed in the discharge summary (DS). Prescription errors were analysed using the total of 2,854 drugs prescribed on HDO. Although hospital pharmacists had signalled discrepancies and provided recommendations to the prescribers via alerting pharmaceutical interventions in CPOE 67 prescription errors (error rate of 2.3%) were found. Errors included 53 cases of refractory period disrespected, four cases of drug interactions, three cases of drug redundancies, and two cases of excessive dosage. CONCLUSION: This study highlights that most HDO were edited via the CPOE system. Together with pharmacist's interventions, the CPOE system contributed to reducing the prescription error rate in HDO. However, discrepancies in the recording process to DS were frequent, calling for reinforcement of error prevention strategies upon the integration of a CPOE system in the hospital's Electronic Health Records. Providing regular training for physicians is also a requirement.