Impact of extensive reform of discharge letter on general practitioners, resident work and management.


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Impact of extensive reform of discharge letter on general practitioners, resident work and management.
Titre de la conférence
81th SGIM/SSMI Annual Meeting
Garnier A., Gachoud D., Gagliano M., Gilliot G., Cappai M., Sartori C., Waeber G., Martinuz M.
Statut éditorial
Date de publication
Communicating medical information is a major challenge because of the number of health providers and increasing cutting edge medical care. Discharge letter(DL) is important but often considered as a burden. In 2011, the Service of Internal Medicine, counting 173 beds, sent 4090 DL. They were issued in an average of 41.2 days. Furthermore, electronic medical record (EMR) were introduced in CHUV. Dictation has lost usefulness. Short medical report(faxmed), produced electronically at the day of discharge, are duplicating DL but without validation of a supervisor. For the chiefs residents and the head of service, it is time to initiate a reform. We must adapt to computerization, maintain quality and reduce delays.
A first task force met late 2011 and developed the concept: no more dictation; writing style has to be telegraphic and synthetic.The DL is extracted from the list of problems build during the stay. Comments are split in 3: background - discussion - proposal.The faxmed is abandoned. But difficulties threaten the reform: resistance to the loss of prose, disagreement on structure and practical problems.
After problem identification, in July 2012, a new task force is created, more strictly coordinated and interdisciplinary (physicians, administrator, secretary and IT support). Responsibilities are divided into 4 areas: EMR, content structure, layout, and standardization of procedures. General practitioners(GP) are surveyed. Tests are conducted in a 25-beds unit.
After 2 months, it appears that the reform induced cascades of changes in way of thinking, working and documenting EMR throughout the stay.The secretariat's work is also redefine.EMR and delays monitoring are improved.
Within the next 3 months, the process is extended to the six other units.Doctors have been specifically trained and coached. Interaction between end-users and task force allowed further improvement.In December 2012, the head of service endorses the reference document. Residents and GP are satisfied.The reflections of the DL shifted upstream of the stay. Although exciting, good synthesis isn't so easy to do. Errors appear more evidently and supervisors still has an important work load. December 31, the mean delay was 11 days.
Despite a large university service, a deep change has been achieved in less than 6 months. This success lies in a coordinated and interdisciplinary task force. The main medical benefit is an upstream shift of the medical reflections.
Création de la notice
30/03/2015 14:29
Dernière modification de la notice
22/01/2020 7:26
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