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出院完善:评估巴基斯坦马尔丹医疗中心的文档质量(2024年首次审计)

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

作者信息

Ali Murad, Hussain Manzoor, Mushtaq Muhammad, Ali Amjad, Zaib Hameed

机构信息

Medicine, Bacha Khan Medical College, Mardan, PAK.

General Medicine, Mardan Medical Complex, Mardan, PAK.

出版信息

Cureus. 2024 Jul 29;16(7):e65625. doi: 10.7759/cureus.65625. eCollection 2024 Jul.

Abstract

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.

摘要

背景

患者出院小结不仅在确保医疗连续性和患者安全方面发挥着至关重要的作用,还是基层医疗与三级医疗机构之间的沟通工具。然而,尽管其至关重要,但大多数出院小结要么不准确,要么遗漏关键临床信息,给患者带来相当大的危险。本次临床审计评估了巴基斯坦马尔丹马尔丹医疗中心出院小结的质量,以确定需要改进的方面。

目的

本研究的目的是评估巴基斯坦马尔丹马尔丹医疗中心患者的出院小结,重点关注其完整性、准确性和及时性。

方法

2023年9月至2023年10月,在巴基斯坦马尔丹马尔丹医疗中心内科A病房开展了一项横断面、观察性和回顾性研究。在897份出院单中,使用Epi Info软件确定了105名参与者的样本量。采用系统随机抽样技术。数据从医院管理信息系统中提取,并使用基于伊斯兰堡皇家内科医师学院、伊斯兰堡医疗监管局和开伯尔-普赫图赫瓦省医疗委员会标准指南的临床审计工具进行评估。为分析数据,应用了描述性统计方法。

结果

临床审计揭示了出院小结存在重大缺陷。在100%的病例中,完全没有患者的重要人口统计学信息,如联系方式和安全警报,48%的小结缺少父亲姓名。入院详情同样不充分,几乎所有小结都缺少入院时间和入院原因等关键信息。73%的病例缺少临床总结,87%的病例缺少诊疗过程细节。出院计划也存在重大差距,根据初步诊断和出院目的地的特殊指示经常被忽视。仅71%的病例建议进行随访。此外,家庭用药处方存在重大错误,61%的处方缺少药物剂量,28%的处方缺少给药途径,20%的处方缺少治疗时长。

结论

本次临床审计通过揭示马尔丹医疗中心出院小结质量存在的重大错误,确定了关键的改进领域。建议实施标准化的出院单模板,对医护人员进行适当培训,并在患者出院前进行全面监测。这些措施旨在提高文档标准。此外,定期进行未来临床审计对于跟踪这些干预措施的影响以及确保患者安全和医疗连续性至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b56/11357728/d96d007e27b9/cureus-0016-00000065625-i01.jpg

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