Department of Pediatrics, Levine Children's Hospital, Carolinas Medical Center, Charlotte, NC, USA.
Pediatrics. 2010 Oct;126(4):734-9. doi: 10.1542/peds.2010-0884. Epub 2010 Sep 27.
Communication between hospital providers and primary care physicians at the time of hospital discharge is necessary for optimal patient care and safety. Content of the inpatient discharge summary (DS) is not uniformly addressed by residency programs.
To improve DSs quality through a brief educational intervention.
We prospectively enrolled interns (first-year pediatric residents [PL1s]) in an educational intervention that consisted of a group session in which components of a high-quality DS were taught and a subsequent brief small-group session in which key components with distribution of a reminder card were reiterated. Six key components were identified: diagnosis; timely completion; pending laboratory work/studies; medications; length ≤3 pages; and discharge weight. DSs prepared by PL1s before and after the small-group session were objectively scored by blinded reviewers on the basis of how many DS components they contained (maximum score: 6). Scores were compared with historical controls of PL1s from the previous year. Audit scores were analyzed by using a mixed-effects linear regression model.
Sixty-four PL1s were enrolled in the study; 477 DSs were scored. Mean score before the small-group reminder session was 3.6 in both groups. In mixed-effects models, scores in the intervention group increased by 0.56 points (P=.002) and DSs incorporating at least 5 of 6 components increased from 22% to 41% (P<.001) after the small-group session, whereas the control group's scores were unchanged.
A brief, low-intensity educational intervention can improve quality of discharge communication and be incorporated into residency training. Electronic templates should incorporate prompts for key components of a DS.
医院提供者与初级保健医生在出院时进行沟通对于优化患者护理和安全至关重要。住院患者出院总结（DS）的内容并未被住院医师培训项目统一涵盖。
通过短暂的教育干预来提高 DS 的质量。
我们前瞻性地招募了参与教育干预的实习医生（第一年儿科住院医师 [PL1]），该干预包括一个小组课程，教授高质量 DS 的组成部分，以及随后的简短小组课程，其中强调了关键组成部分并分发了提醒卡。确定了六个关键组成部分：诊断；及时完成；待处理的实验室工作/研究；药物；长度≤3 页；以及出院体重。PL1 在小组课程前后准备的 DS 通过盲审员根据他们包含的 DS 组成部分数量进行客观评分（最高分数：6）。将分数与前一年 PL1 的历史对照组进行比较。使用混合效应线性回归模型分析审核分数。
共有 64 名 PL1 参与了研究；共评分了 477 份 DS。在小组提醒课程之前，两组的平均分数均为 3.6。在混合效应模型中，干预组的分数增加了 0.56 分（P=.002），并且在小组课程后，纳入至少 6 个组成部分中的 5 个的 DS 从 22%增加到 41%（P<.001），而对照组的分数则没有变化。
简短的、低强度的教育干预可以改善出院沟通的质量，并纳入住院医师培训。电子模板应纳入 DS 的关键组成部分的提示。
