Improving Timeliness of Patient Discharge Summaries within Orthopaedic Surgery: A Quality Improvement Initiative

The discharge summary is crucial for transitioning from inpatient to outpatient care, serving as a key communication tool between hospital and primary care providers. Our multi-site, high-volume tertiary care orthopedic division was identified as a low performer in completing discharge summaries within the institutional 48-hour target. This quality improvement initiative aimed to improve the timeliness of discharge summary completion, targeting >80% completion within 48 hours by June 30^th, 2023.

This study aimed to achieve at least 80% discharge summary completion within 48 hours in the Division of Orthopaedic Surgery.

An interrupted time series study, based on the Institute for Healthcare Improvement’s ‘Model for Improvement’, was conducted. A quality committee, including representatives from each Clinical Teaching Unit (CTU), a resident representative, and two quality facilitators, utilized root cause analysis, stakeholder interviews, process mapping, and driver diagrams. Interventions included implementing an auto-authenticate option, an audit and feedback system, and engaging medical residents and nurse practitioners. Monthly data tracking used statistical process control charts.

Pre-implementation, the completion rate within 48 hours was 48%. Auto-authentication significantly improved completion rates, with 63% completed within 48 hours compared to 16% with manual authentication. Overall, completion rates rose from 48% to 89%, with auto-authentication usage increasing from 50% to 91%.

This initiative significantly improved timely discharge summary completion, meeting targets. Key success factors included stakeholder engagement, timely performance data, and effective root cause analysis. Medical resident involvement and the audit and feedback system fostered improvements, enhancing patient transitions from hospital to outpatient care.