Improving the efficiency of discharge summary completion by linking to preexisiting patient information databases.

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.

Improving the quality of hospital discharge summaries utilising an electronic prompting system.

The discharge summary (DS) is a summary of an inpatient admission, patient's health state, and future treatment plans which is delivered to the patient's primary care provider. The DS is often incomplete, inaccurate, or unclear. The aim of this project was to improve the quality of the DS through the use of an electronic prompting system. The electronic prompting system was implemented in the acute medical and surgical wards of the hospital as an adjunct to a pre-existing, widely used hospital program that documents all the patients in a ward or belonging to a particular treating team. When using the program, a doctor enters information (with the assistance of the treating consultant) from a drop-down menu and is prompted to include common, departmental specific diagnoses, co-morbidities, complications, and procedures that were commonly missed or documented incorrectly in the DS. Fifteen DSs were randomly selected from a two month period immediately prior to the intervention period and were rated by an external, experienced general practitioner (GP) using a scoring system consistent with the Australian Medical Association Guidelines for quality DSs. Fifteen random DSs from a two month period, four months post-implementation were also rated by the same GP. The quality of the DS improved in all categories evaluated. The overall quality improved from mean (± SD) 2.86 ± 1.64 to 4.13 ± 0.92 out of 5 (p = 0.031). Additionally the implementation of the system was associated with improvements in documentation of the diagnosis, co-morbidities and other relevant clinical information. In summary, electronic prompting systems can improve the quality of DSs to ensure the information contained within the DS is more accurate and complete.

Percutaneous gelfoam embolization of chronic enterocutaneous fistulas: report of three cases.

PURPOSE: A relatively simple radiologically guided method for the treatment of enterocutaneous fistula by gelfoam embolization is described. METHODS: Three cases of chronic enterocutaneous fistula are presented. In each case, a sheath was positioned with its tip at the enteric opening of the fistula. Gelfoam was injected to occlude the fistula at its enteric opening. RESULTS: In each case, there was successful closure of the fistula. CONCLUSIONS: Radiologically guided embolization with gelfoam is a safe, relatively simple procedure, which may be useful in the treatment of chronic enterocutaneous fistula.