Review article: Components of a good quality discharge summary: a systematic review

Abstract

Objective: The present study aims to inform the use of discharge summaries as a marker of the quality of communication between ED and primary care; this systematic review aims to identify a consensus on the key components of a high-quality discharge summary.

Method: A systematic search of the major medical and allied health databases and Google Scholar was conducted, using predetermined criteria for inclusion. Two authors independently reviewed the full texts of potentially relevant studies to determine eligibility for inclusion. Data were extracted using a standard form, and the level of evidence was assessed using a predetermined scale.

Results: We screened 827 articles, and 84 articles underwent full-text review. Thirty-two studies were included, and 15 studies were level A or B studies. The agreement between authors for level of evidence was good: k = 0.62 (95% confidence interval [CI] 0.4-0.84) and for which components were included was 1011/1056, 95.7% (95% CI 94.3-96.8%). Thirty-four components were identified; however, only four were ranked as important by ≥80% of respondents or scored ≥80% on a scale of importance. These were: discharge diagnosis, treatment received, investigation results and follow-up plan. The quality of information contained in summaries was incompletely assessed in most studies.

Conclusion: The key components to include in a discharge summary are the discharge diagnosis, treatment received, results of investigations and the follow up required. The limited evidence pertaining to ED discharges was consistent with this. The adequacy of the components rather than just their presence or absence should also be considered when assessing the quality of discharge summaries.

Keywords: communication; emergency service; hospital; primary healthcare; quality indicator; review.