UCSF

Background

Successful transitions of care require communication between inpatient and outpatient physicians. The discharge summary is the main communication tool used by physicians during these transitions.

Objective

With the goal of improving care transitions, we explored primary care physicians (PCPs) perspectives on characteristics of high-quality discharge summaries.

Design

We conducted semi-structured individual interviews in this qualitative study and surveyed participants for sociodemographic characteristics.

Participants

PCPs were recruited from multiple health systems in California.

Approach

An interview guide was created by the study authors to solicit PCPs' experiences with discharge summaries and perspectives on four discharge summary templates previously used by large health systems. Interviews were transcribed verbatim and qualitative data were analyzed interactively through thematic analysis.

Key results

Twenty PCPs participated in interviews lasting an average of 35 min (range 26-47 min). Sixty percent were female. Most (70%) had trained in internal medicine (IM); 5% had trained in both IM and pediatrics and 25% in family medicine. Some (45%) participants practiced both inpatient and outpatient medicine; 55% had exclusively outpatient practices. Half worked in university-affiliated clinics, 15% community clinics, 15% public health clinics, 5% private practice, and 15% multiple clinic types. Many PCPs (65%) had been in practice for ≥ 10 years. Participants reported multiple concerns with typical discharge summaries, including frustration with lengthy documents containing information irrelevant to outpatient care. Suggested recommendations included beginning the discharge summary with action items, clear identification of incidental findings requiring follow-up, specifying reasons for any medication changes, and including dates for treatment regimens rather than expected duration of treatment. Participants highlighted the importance of feedback to trainees to assist in crafting succinct discharge summaries containing relevant information.

Conclusion

Clinical training programs and healthcare systems must optimize discharge summaries for PCPs to achieve goals of providing high-quality care that improves population health.