Smart AIM: 
With a more formalized discharge instruction evaluation process for PGY-1s, discharge instructions for specific diagnoses will have less error in a year’s time.https://jdc.jefferson.edu/patientsafetyposters/1035/thumbnail.jp

Ackermann, MD, Lily

Ghusson, MD, Noha

Riggio, MD, Jeffrey

Vershvovsky, MD, Maria

Zhang, MD, Jinyu

English

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsHouse Staff Quality Improvement and PatientSafety Posters GME Quality and Safety5-31-2017Should we Set a Formalized Discharge InstructionEducation Standard?Jinyu Zhang, MDThomas Jefferson University Hospital, Jinyu.Zhang@jefferson.eduMaria Vershvovsky, MDThomas Jefferson University Hospital, Maria.Vershvovsky@jefferson.eduNoha Ghusson, MDThomas Jefferson University Hospital, noha.ghusson@jefferson.eduJeffrey Riggio, MDThomas Jefferson University Hospital, Jeffrey.Riggio@jefferson.eduLily Ackermann, MDThomas Jefferson University Hospital, lily.ackermann@jefferson.eduFollow this and additional works at: http://jdc.jefferson.edu/patientsafetypostersPart of the Medicine and Health Sciences CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inHouse Staff Quality Improvement and Patient Safety Posters by an authorized administrator of the Jefferson Digital Commons. For more information,please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationZhang, MD, Jinyu; Vershvovsky, MD, Maria; Ghusson, MD, Noha; Riggio, MD, Jeffrey; and Ackermann, MD, Lily, "Should we Set aFormalized Discharge Instruction Education Standard?" (2017). House Staff Quality Improvement and Patient Safety Posters. Poster 23.http://jdc.jefferson.edu/patientsafetyposters/23Should We Set a Formalized Discharge Instruction Education Standard? Jinyu Zhang, MD, Maria Vershvovsky, MD, Noha Ghusson, MD, Jeffrey Riggio, MD, Lily Ackermann, MD Department of Medicine, Thomas Jefferson University, Philadelphia, PA BACKGROUND • Discharge instructions are integral to safe hospital discharges and patient safety. • TJUH internal medicine residents and hospitalists polled in Fall 2014 showed that over two-thirds of respondents favored a process of formal training. INTERVENTION Two Part Intervention 1. PGY-1 residents underwent a presentation at orientation instructing on correct elements of discharge instructions in accordance with guidelines from the 2007 Transitions of Care Consensus Conference. 2. A requirement was implemented in which discharge instructions completed by PGY-1s were formally reviewed as a core competency.  • In our DKA and HHNK group, mean score was 93.3% (n=18) pre-intervention and 91.4% (n=14) post-intervention (p=0.8626). • In our AFib, DVT, and PE group, mean score was 87.4% (n=26) pre-intervention and 94.7% (n=29) post-intervention (p=0.1441).      METHODS • A point system of grading the completion of discharge instructions was formalized. • DKA and HHNK were scored the same way and focused on glucose management. • AFib, DVT, and PE were scored the same way and focused on anticoagulation management.   Donaldson J, Ghusson N, Thanawala P, Vershvovsky M, Zabolotsky A, Zhang J, Ackerman L, Riggio J. Instituting a standardized discharge instruction evaluation. 2015 Thomas Jefferson University Spring Quality Improvement Poster Symposium, Philadelphia, PA, USA, June 4, 2015 Accreditation Council for Graduate Medical Eduction [May 5, 2015]; Common Program Requirements. https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs_07012016.pdf  Kashiwaqi, DT, et al. Reflective practice: a tool for readmission reduction. Am J Med Qual. 2015 Feb 6; Epub ahead of print. Sheu, L. et al. We need to talk: primary care provider communication at discharge in the era of a shared electronic medical record. J Hosp Med. 2015 May; 10(5): 307-10. Yemm R. et al. What constitutes a high quality discharge summary? A comparison between the view of secondary and primary care doctors. Int J Med Educ. 2014 Jul 5; 5:125-31. Kripalani, S., et. al. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007 Feb 28;297(8):831-41.   SMART AIM • Discharge Instructions completed in late July – September 2014 (pre-intervention) were compared to those completed in late July – September 2015 (post-intervention) for general internal medicine patients with the following diagnosis: diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar non-ketotic state (HHNK), atrial fibrillation (AFib), deep venous thrombosis (DVT), and pulmonary embolism (PE). DKA and HHNK Score Sheet Checklist Yes Partial No Was the diabetes mellitus section completed (insulin, oral meds, fasting glucose checks)? 2 1 0 Was appropriate follow up with PCP or endocrinologist made? 2 (if include name and phone number) 1 (if include only name or phone number) 0 (no date or phone number) Was appropriate diet marked in discharge instruction? 1 n/a 0 AFib, PE, and DVT Score Sheet Checklist Yes Partial No Was the correct anticoagulation identified? 1 n/a 0 If discharged on warfarin, was the warfarin section completed appropriately? 2 1 0 Is there appropriate follow up with PCP or lab draws?  2 1 0 Are there instructions for administration? 2 1 0 RESULTS DISCUSSION • Although our data does not show significance in pre versus post-intervention data with formal training, this is a pilot study and our n is small.   • More longitudinal follow-up is needed especially with new EPIC. • We also plan to study the post-intervention perceptions from residents and attending physicians regarding discharge instruction quality.     BIBILIOGRAPHY * Those discharged on aspirin were excluded With a more formalized discharge instruction evaluation process for PGY-1s, discharge instructions for specific diagnoses will have less error in a year’s time. • ACGME requires programs to assess residents in transitions of care although there is no specific requirement or formal training in discharge instructions. 

Should we Set a Formalized Discharge Instruction Education Standard?

Smart AIM: 
With a more formalized discharge instruction evaluation process for PGY-1s, discharge instructions for specific diagnoses will have less error in a year’s time.http://jdc.jefferson.edu/patientsafetyposters/1035/thumbnail.jp

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https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1035&amp;context=patientsafetyposters

Should we Set a Formalized Discharge Instruction Education Standard?

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