The Ideal Hospital Discharge Summary: A Survey of U.S. Physicians

Background: Hospital discharge summaries enable communication between inpatient and outpatient physicians. Despite existing guidelines for discharge summaries, they are frequently suboptimal. Objective: The aim of this study was to assess physicians’ perspectives about discharge summaries and the differences between summaries’ authors (hospitalists) and readers (primary care physicians [PCPs]). Methods: A national survey of 1600 U.S. physicians was undertaken. Primary measures included physicians’ preferences in discharge summary standardization, content, format, and audience. Results: A total of 815 physicians responded (response rate = 51%). Eighty-nine percent agreed that discharge summaries “should have a standardized format.” Most agreed that summaries should “document everything that was done, found, and recommended in the hospital” (64%) yet “only include details that are highly pertinent to the hospitalization” (66%). Although 74% perceived patients as an important audience of discharge summaries, only 43% agreed that summaries “should be written in language that patients…can easily understand,” and 68% agreed that it “should be written solely for provider-to-provider communication.” Compared with hospitalists, PCPs preferred comprehensive summaries (68% versus 59%, P = 0.002). More PCPs agreed that separate summaries should be created for patients and for provider-to-provider communication than hospitalists (60% versus 47%, P < 0.001). Compared with PCPs, more hospitalists believe that “hospitalists are too busy to prepare a high-quality discharge summary” (44% versus 23%, P < 0.001) and “PCPs have insufficient time to read an entire discharge summary” (60% versus 38%, P < 0.001). Conclusions: Physicians believe that discharge summaries should have a standardized format but do not agree on how comprehensive or in what format they should be. Efforts are necessary to build consensus toward the ideal discharge summary.