The Effect of Implementing a Standardize Process on the Quality of Discharge Summaries

1. The Effect of Implementing a Standardize Process on the Quality of Discharge Summaries Eyad Almidani, MD Head, Neonatal Critical Care Chairman, Pediatrics' Quality Management Team Department of Pediatrics, KFSH&RC Riyadh, KSA

3. Kingdom of Saudi Arabia

4. Riyadh

5. King Faisal Specialist Hospital andResearch Centre (KFSHRC) is a 936-bed tertiary care facility

6. Patients Care There are 18 Medical Departments, each with its own Chairman The names of these departments are set out in the accompanying Organizational Structure.

7. Personnel The Hospital and Research Centre has a total staff of 6,946, comprising 63 different nationalities. The Medical Staff Including Saudi Residents and Fellows, totals 703, 46% of whom are Non-Saudis (including 16% U.S./Canadian and 11% European) and 54% of whom are Saudis.

8. The Nursing Staff Totals 1,942 and 18% from Canada and 11% from the United States. The other Nursing staff are from the United Kingdom, Europe, Australia, New Zealand, the Philippines, Saudi Arabia, and other countries.

9. 80 Beds (Excluding: Normal Newborn Nursery, Pediatric Patients in the ER, Day Medical Unit) • 2 OR Sessions (GI and Pulmonology) • 65 Outpatient Clinics / week Department of Pediatrics, KFSHRC

10. Department of Pediatrics

11. Yearly number of discharged patients: • 2011 2826 • 2012 2832 • 2013 2651 • 2014 2556

12. Background: • Timely transfer of accurate and relevant diagnostic findings, treatment plans, complications, consultations, tests pending at discharge and arrangements for post discharge follow-up may improve the continuity of this handoff. • By contrast, delayed communication or inaccuracies in information transfer among health care professionals, particularly during the early post discharge period, may have substantial implications for continuity of care, patient safety, patient and clinician satisfaction, and resource used.

13. Example of an inappropriate Discharge Summary before project implementation

14. Objective: • To assess the compliance rate and overall quality of discharge summaries among KFSH & RC patients according to JCIA standards, over three years.

15. Methods: • The idea was initiated at the Department of Pediatrics in collaboration with other concerned departments on June 2012. • Departmental Staff Meeting in October 2012 • Project Initiated officially at the 4th quarter 2012

16. Algorithm

17. A standardized format

19. Adherence is monitored by: • A weekly round with the senior resident/ fellow, or assistant to follow -up the adherence by the junior resident to all the steps mentioned in the algorithm. • A daily report is provided from the medical records for all patient who have been discharge in the preceding 24hrs

20. Daily Report

21. Results: • Better quality of discharge summaries • Less number of delinquent charts • Positive feedback from the majority of our staff

22. Number of Delinquent Records

23. Discharge documentation compliance Report Q1 2011 TO Q2 2014

29. Thank You..

30. References: • Alpers A. Key legal principles for hospitalists. Am J Med. 2001; 111:5S-9S. • Goldman L, Pantilat SZ, Whitcomb WF. Passing the clinical baton: 6 principles to guide the hospitalist. Am J Med. 2001; 111:36S-39S. • Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med. 2004; 141:533-536. • Coleman EA, Min SJ, Chomiak A, Kramer AM. Post hospital care transitions: patterns, complications, and risk identification. Health Serv Res. 2004; 39: 14491465. • van Walraven C, Mamdani M, Fang J, Austin P. Continuity of care and patient outcomes after hospital discharge. J Gen Intern Med. 2004; 19:624- 31.