Discontinuity of care at hospital discharge---can the discharge summary close the gap?

Communication between hospitalists and primary physicians at discharge is notoriously poor. Discharge summaries, which are supposed to address this problem, tend to be lacking in useful information and timeliness.

So what’s the most effective discharge summary? Discussants in a recent article in ACP Hospitalist seemed to agree that a uniform template is best, containing these key elements:

Problem that led to hospitalization
Key findings and test results
Final diagnoses (primary and secondary)
Brief hospital course
Condition at discharge
Discharge destination
Medications at discharge
Follow-up appointments and proposed management plan
Anticipated problems and suggested interventions
Pending laboratory work and tests
Recommendations of subspecialty consultants
Documentation of patient education
Name and 24-hour phone number for hospital physician records.

One advantage of the electronic medical record, which generates this type of summary, is speed. You can create the summary on the spot with a few clicks, and if the PCP is not in your network you can give the patient a printed copy to take to the follow up appointment.

A part of me longs for the days of the old fashioned narrative summary. It told the patient’s story as well as what the doctors were actually thinking (or whether they were thinking at all).