discharge summaries-long-

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I have cross posted this becasue- on the aafp listserv clinical has more

teacehers who may have thoughts about this,

on the aafp list serv emrs people know about electronic stuff

on the aapfp pratice management mostly this is a blog but there are

some good minds out there and

on practiceimprovement1 there are people making changes in intereseting

positive ways

I am interesed in finding a way to improve the quality of dishcarge

summaries A hospitalist is willing towork with meonthis.

Some of you do your own hospital work , and read- if you do - your own

summaries and there is no big issue no matter what the content of the

summary is, as you did the work. Most dictations I have seen even in-house

office notes , are full of gibberish and they get signed filed and no one

needs to proof read them while the patient care stays inthat office..

For me there is a big issue .I do outpatient only and a lot of skilled care

taking people from several hospitals

Discharge summaries are uniformly mediocre

Soemtimes it is a matter of clealry a typo- but when are those

acceptobale? " BUN 1 " but what WAS it?

" She went to the er after her MVA becasue of the pregnancy Unfortuanletey

the preganancy was not in jeopardy " . Fortunately.

Meds have no associated diagnosis.Over and over again .Now that is a

problem becasue in the SNF setting I must write a dx for every med.(what a

concept eh?) I can guess alot But should I be guessing?There can be more

than one reason why they are on... desmopressin!

SOme meds everyone is on-- PPI's. Does everyone really need one? Why is

there no dx supporting it?

internal errors- the dose of nitrate on the list on p 1 is not the dose in

the text on p 3

Some people come in the hospital and when they leave are on different

meds I beleive that the summary should explain this. Silly me.

On and on

Sometimes blatently silly statements.

Mostly d/c summaries have the propensity to be a chore done by someone who

did not care for the patietn in the hospital but must " do the summary "

So

I have delineated the problem

Who has a painless solution?

Tha t is , cannot there be a way to do the dishacrge summary as the

hospitalization goes along- a template that is populated with a problem list

an the hospital course of these/list of consultations/ /meds added or d/c

/and then it can be simply polished the last day?

Could this be done on a EMR that " Parsed " things to a d/c summary template?

MY emr can parse but I do not use it in hospital work.. but I guess I could

set this up-- so could this be done SIMPLY ?

what if we got a grant to buy or (required a purchase of) PDA palm

pilots by hospitalists in our hospital-start in my hospital and I will

write this up and take it elsewhere Do Palm pilot devices have anything

like an emr they could parse .Can they be hooked up to Print?

Feebcak please to tune up my roughed out idea

I think that if you read- as my patietns have- what these d/c summaries say

and it was about you or your mother you would not be happy

If we are going to pursue quality inthis country this is a micro level of

quality that consumes alot of time and casues errors.(And I left out that

I never ever am told code status on all these eldery people barely

crawling to SNF to see if they can get home)

Ideas?