Bridging the Gap: The Impact of a 4-cycle, 3-year Departmental Audit on Discharge Summary Quality in a Geriatric Medicine Service

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Abstract Background Discharge summaries are a vital method of communication and critical for safe patient transitions. We sought to improve the quality of our discharge summaries through continual departmental audit against the National Standard for Discharge Summary Information (HIQA, 2013). We compared results across four audit cycles since 2022. Methods In each audit, 20 patients were selected at random from the preceding three months. Their electronic discharge summary and paper based medical notes were compared against the HIQA standards. Five key elements were examined: clinical course, complications, primary diagnosis, discharge medications and follow-up. Post Cycle1 interventions included creating an NCHD-designed flowchart, targeted education sessions and weekly reports on outstanding summaries to consultants. Data was analysed using Stata V15. Binary outcomes were compared between Cycle 1 and Cycles 2–4 using Pearson’s Chi-square test (p < 0.05). A composite outcome (5 key elements) was analysed using logistic regression. Results Significant improvements were made and sustained in documentation of the clinical course (40%-75%, p = 0.004), primary diagnosis (85%-100%, p = 0.002), and stopped medications (40%-70%, p = 0.016). Communication of future-plans (85%-97%, p = 0.062) and ideal summaries (20%-40%, p = 0.104) showed positive trends but did not reach statistical significance. Documentation of new or changed medications (85%-75%, p = 0.354), complications (80%-85%, p = 0.600), and complete discharge medications (57%-60%, p = 0.794) remained stable across cycles. Discharge summary quality improved significantly across cycles, with Cycles 2–4 scoring 0.63 points higher on a 5-point composite scale than Cycle 1 (p = 0.022). Conclusion NCHD-led continual audit, education sessions, a targeted flowchart and weekly reports resulted in significant and sustained improvements in the quality of discharge summaries. In addition to these interventions, we recommend the implementation of end-to-end electronic patient records to improve the accuracy of medication documentation.

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