Chan Samuel, Maurice Andrew P, Pollard Clifford W, Ayre Stephen J, Walters Darren L, Ward Helen E
The Prince Charles Hospital, Brisbane, Queensland, Australia.
BMJ Qual Improv Rep. 2014 May 16;3(1). doi: 10.1136/bmjquality.u200548.w2006. eCollection 2014.
The discharge summary (DS) is a document that contains the diagnosis, comorbidities, procedures, complications, and future treatment plan for a particular patient after an inpatient hospital stay. The DS is completed by junior medical staff and is delivered to the general practitioner (GP). DS completion is time consuming and tedious, and DSs are usually not completed within the recommended time frame after a patient is discharged. Time spent completing DSs correlate to junior doctor overtime, which costs the hospital money in overtime pay. Information that is required in the DS is generally already entered into numerous electronic information systems in the hospital, including the "electronic patient journey board" which lists all the patients in a given ward with their clinical information. This information is constantly updated by all staff in the hospital. A program was developed that transferred this information directly into the patient DS. Ten junior doctors in two departments kept daily records for one week of the time spent compiling DSs, the time at work and the actual overtime claimed, before and after the introduction of the intervention. The mean (± SD) time for DS compilation per week reduced by 2.8 (± 2.4) hours from 10.0 (±3.5) hours (p<0.01) and the mean overtime worked per week reduced by 2.8 (± 3.1) hours from 8.5 (± 4.4) hours (p<0.05). The mean overtime claimed reduced by 1.8 (± 2.8) hours from 5.3 (± 5.4) hours per week (p<0.05), resulting in reduction in mean overtime payment of $114.95 from $290.57 per doctor, per week. Extrapolating to the 60 ward based junior doctors, the potential annual savings for the hospital budget are over $350,000. Additionally, the number of DSs completed within 48 hours increased from 45% to 58%. In summary, the transfer of electronic data from the electronic patient journey board to the discharge summary program has yielded improvements in DS completion rates and overtime worked by medical staff, resulting in significant reduction in overtime costs.
出院小结（DS）是一份包含特定患者住院后诊断、合并症、手术、并发症及未来治疗计划的文件。出院小结由初级医务人员完成并交付给全科医生（GP）。完成出院小结既耗时又繁琐，而且通常在患者出院后的推荐时间内无法完成。完成出院小结所花费的时间与初级医生的加班时间相关，这会使医院在加班费上花费资金。出院小结所需的信息通常已录入医院众多电子信息系统，包括列出特定病房所有患者及其临床信息的“电子患者行程板”。该信息由医院全体工作人员不断更新。开发了一个程序，可将这些信息直接传输到患者的出院小结中。两个科室的十名初级医生在引入该干预措施前后，连续一周每天记录编写出院小结所花费的时间、工作时间及实际申报的加班时间。每周编写出院小结的平均（±标准差）时间从10.0（±3.5）小时减少了2.8（±2.4）小时（p<0.01），每周平均加班时间从8.5（±4.4）小时减少了2.8（±3.1）小时（p<0.05）。每周平均申报的加班时间从5.3（±5.4）小时减少了1.8（±2.8）小时（p<0.05），导致每位医生每周的平均加班费从290.57美元减少到114.95美元。推算到60名病房初级医生，医院预算每年潜在节省超过35万美元。此外，48小时内完成的出院小结数量从45%增加到58%。总之，将电子患者行程板的电子数据传输到出院小结程序提高了出院小结完成率和医务人员的加班效率，从而显著降低了加班成本。
