2010 Award Winner

Electronic Discharge Summaries

Category - Improving Integration

The Problem

The purpose of a hospital discharge summary is to communicate the details of a patient's hospital stay to the primary caregiver, usually the family physician. This is extremely important because family physicians generally have not participated in the care process during hospitalization, and the information contained in the discharge summary is necessary to ensure continuity of care. Previously, discharge summaries at Sunnybrook were created by voice dictation, followed by transcription to a paper report. A separate handwritten discharge notification was then completed and would be given to the patient before departure, which in essence was duplicating efforts. In this approach, timeliness was an issue, with days if not weeks going by before the summary was completed and mailed to the family physician. In addition, both the structure and content of discharge summaries at Sunnybrook were non-standardized, resulting in a final product that was of inconsistent quality or accuracy.

The Innovation

Sunnybrook's development of an electronic discharge summary system (eDischarge) in 2008 promises to substantially alleviate many of the shortcomings that existed with the hospital's patient discharge summaries. In 2009, the eDischarge system was pilot-tested for two months within General Internal Medicine (GIM), to work out any technical or process related difficulties. Under the new system, electronic discharge summaries are automatically populated with data at the time of discharge by integrating with Sunnybrook's existing clinical systems, greatly improving the efficiency of the summary completion process. Further, an electronic format has facilitated the ability to automatically fax the discharge summary to the family physician, reducing delays considerably.

The Results

Implementation of eDischarge has been a great success, and significant positive changes in clinical workflow have been realized. High quality discharge summaries provided to the right caregiver at the right time have helped to reduce readmissions, reduce drug errors, and promote positive outcomes for hospitalized patients at high risk for re-hospitalization. In addition, quicker turnaround time for the production and delivery of discharge documentation has improved productivity, and the reduction in the amount of transcription required has decreased costs. Receiving physicians appreciate the timeliness of the discharge summaries. Receiving pharmacists appreciate legible, complete prescriptions with accompanying discharge medication instructions.

Next Steps

Although end-user feedback has been very positive, the use of the system continues to be monitored, and any issues will be addressed in future releases. Following the success of the pilot, physicians in other departments have been migrated to the new system in an incremental manner, with completion expected by end of 2011.