During my Internal Medicine training, I wrote 100s of discharge (d/c) summaries.
In my PGY4 chief year, I was an outpatient attending and reviewed many d/c summaries.
Here are some tips and tricks for your d/c summaries.
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In my PGY4 chief year, I was an outpatient attending and reviewed many d/c summaries.
Here are some tips and tricks for your d/c summaries.
-thread ๐งต-
#MedTwitter #MedEd #Cardiotwitter #IMG
First of all, why do d/c summaries matter?
- They matter because effective transitions of care (inpatient to PCP setting) can lead to better clinical outcomes and decreased hospital (re)-admissions.
- It is a conversation through words between the primary team and PCP
- They matter because effective transitions of care (inpatient to PCP setting) can lead to better clinical outcomes and decreased hospital (re)-admissions.
- It is a conversation through words between the primary team and PCP
1) Reason for Presentation to the ER:
- Similar to the H&P, this is important for the PCP to know.
- It can be a few words, "chest pain, abdominal pain, uncontrolled hypertension."
- As a PCP, I would think: "Could this presentation been prevented?"
- Similar to the H&P, this is important for the PCP to know.
- It can be a few words, "chest pain, abdominal pain, uncontrolled hypertension."
- As a PCP, I would think: "Could this presentation been prevented?"
2) Hospital Course
- Brevity (you can condense the entire hospital course into a short paragraph, again doesn't have to be a novel!)
- Include relevant labs, consultants advice, and diagnostic testing
- It should a patient's story that can be reviewed in the clinic
- Brevity (you can condense the entire hospital course into a short paragraph, again doesn't have to be a novel!)
- Include relevant labs, consultants advice, and diagnostic testing
- It should a patient's story that can be reviewed in the clinic
An example:
60-year old male w/ known COPD presented with a chief complaint of wheezing, cough, and dyspnea. He was stable on presentation. CXR showed no new infiltrate. Patient was given Azithromycin, duo-nebs, and d/c on Prednisone the next day for PCP follow-up.
60-year old male w/ known COPD presented with a chief complaint of wheezing, cough, and dyspnea. He was stable on presentation. CXR showed no new infiltrate. Patient was given Azithromycin, duo-nebs, and d/c on Prednisone the next day for PCP follow-up.
This above example is much shorter than a typical hospital course, but should communicate:
- Clinical Impression
- Relevant Diagnostic Treatment
- Medical Treatments
- Duration of Hospitalization
- Clinical Impression
- Relevant Diagnostic Treatment
- Medical Treatments
- Duration of Hospitalization
3) Medication Changes
- Many times inpatient medical teams make changes to patient's home regimen based on new clinical data
- This can cause confusion to many patients, since during hospitalization it may be hard to fully process all the information.
- Many times inpatient medical teams make changes to patient's home regimen based on new clinical data
- This can cause confusion to many patients, since during hospitalization it may be hard to fully process all the information.
3) Medication Changes
- If there is documentation and reasoning behind WHY there were medication changes, it can make it easier for the PCP to understand the reasoning.
- Remember the PCP usually can't ask the d/c team questions
- I.e. Home Lisinopril held on d/c due to AKI
- If there is documentation and reasoning behind WHY there were medication changes, it can make it easier for the PCP to understand the reasoning.
- Remember the PCP usually can't ask the d/c team questions
- I.e. Home Lisinopril held on d/c due to AKI
4) Instructions for PCP
- This is a great if you can create a separate section for the PCP to review (similar to an assessment/plan for other inpatient team member)
- This shows clear thought and things that you believe that can (and need) to be followed up as an outpatient
- This is a great if you can create a separate section for the PCP to review (similar to an assessment/plan for other inpatient team member)
- This shows clear thought and things that you believe that can (and need) to be followed up as an outpatient
Few examples:
- Repeat BMP ordered for AKI one week after discharge, please follow up Cr
- Home outpatient PT set-up, please ensure patient has started
- Patient had his Carvedilol increased from 3.125 mg BID to 6.25 BID, please follow-up on home HR and BP trends
- Repeat BMP ordered for AKI one week after discharge, please follow up Cr
- Home outpatient PT set-up, please ensure patient has started
- Patient had his Carvedilol increased from 3.125 mg BID to 6.25 BID, please follow-up on home HR and BP trends
I hope this helps!
When writing your d/c summaries, remember that PCPs will review them thoroughly. To highlight some key components:
1) Reason for ER presentation
2) Hospital Course
3) Medication Changes
4) Instructions for PCP
Comment below and let me know your thoughts
When writing your d/c summaries, remember that PCPs will review them thoroughly. To highlight some key components:
1) Reason for ER presentation
2) Hospital Course
3) Medication Changes
4) Instructions for PCP
Comment below and let me know your thoughts
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