Journal of General Internal Medicine

, Volume 26, Issue 1, pp 28–32

The Effect of Workload Reduction on the Quality of Residents’ Discharge Summaries

  • Margaret H. Coit
  • Joel T. Katz
  • Graham T. McMahon
Original Research

DOI: 10.1007/s11606-010-1465-z

Cite this article as:
Coit, M.H., Katz, J.T. & McMahon, G.T. J GEN INTERN MED (2011) 26: 28. doi:10.1007/s11606-010-1465-z

Abstract

Background

The completeness of hospital discharge summaries may reflect the overall quality of inter-professional communications. The effect of reducing resident workload on clinical performance is largely unknown.

Objective

We examined the impact of reducing housestaff workload on the quality of discharge summaries, an indicator of clinical performance, as compared to discharge summaries created by trainees on a team with a more typical workload.

Design

Patients admitted to a medicine service at a community teaching hospital affiliated with an academic medical center were alternately allocated between a control and intervention care team of residents. First-year residents on the intervention team carried an average census of 3.5 patients compared with 6.6 patients for peers on the control team. A random selection of 142 discharge summaries from a 3-month period were blindly evaluated using a structured tool based on professional documentation standards.

Participants

61 internal medicine residents.

Main Results

Inter-rater reliability of discharge summary quality was 0.9. Discharge summaries produced by residents on the intervention team with a reduced workload had significantly more of the required elements (74 vs 65%, p < 0.001). Intervention team summaries were more frequently complete and contained significantly more of the required elements describing the patient history (65.7% vs 36.1%, p = 0.0005), the inpatient narrative (47.1% vs 22.2%, p = 0.003), discharge planning (20.0% vs 5.5%, p = 0.012), and continuity of care (24.3% vs 6.9%, p = 0.005). Fewer than a quarter of the summaries reviewed included discharge instructions, information on follow-up care, or a discharge medication list.

Conclusions

Reducing resident workload can significantly improve discharge summary quality, a measure of resident performance.

KEY WORDS

discharge summaryresidency designwork hours

Supplementary material

11606_2010_1465_MOESM1_ESM.pdf (33 kb)
ESM 1(PDF 33 kb)

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Margaret H. Coit
    • 1
  • Joel T. Katz
    • 1
  • Graham T. McMahon
    • 1
  1. 1.Department of MedicineBrigham and Women’s HospitalBostonUSA