Using a Structured Discharge Letter Template to Improve Communication During the Transition from a Specialized Outpatient Diabetes Clinic to a Primary Care Physician

详细信息    查看全文

• 作者：Mary-Anne Doyle ; MD ; FRCPC ; Janine C. Malcolm ; MD ; FRCPC ; ^{jamalcolm@ottawahospital.on.ca" class="auth_mail" title="E-mail the corresponding author} ; ^{janine.malcolm@rogers.com" class="auth_mail" title="E-mail the corresponding author} ; Dora Liu ; MD ; FRCPC ; Julie Maranger ; BScN ; Teik Chye Ooi ; MBBS ; FRCPC ; Erin Keely ; MD ; FRCPC
• 关键词：Consultation letters ; Diabetes ; Discharge letter ; Letter templates ; Transition of care
• 刊名：Canadian Journal of Diabetes
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：39
• 期：6
• 页码：457-466
• 全文大小：945 K

文摘

Transition from specialists to primary care physicians is dependent on clear communication by means of a discharge letter. Primary care physicians have indicated that letters from specialists rarely contain the details they require. As part of a quality-improvement project to improve the transition from diabetes clinics to primary care physicians, a structured discharge letter template was developed to facilitate the dictation of useful letters by specialists. The objective was to evaluate the content and quality of discharge letters created using a structured discharge letter template as compared to letters completed without the template.

Methods

Retrospective study of patients treated at the Ottawa Hospital and discharged from the outpatient diabetes clinic between November 1, 2009, and December 1, 2010. The letters were reviewed by 2 independent reviewers and were assessed for content, brevity, clarity, management plan, organization and quality. Word count, dictation and transcription times were also compared.

Results

Letters completed using the structured discharge letter template were more comprehensive and more likely to contain guidelines on management for glycemic control (51.1% vs. 14.1%; p<0.001); cardiovascular risk factors (65.61% vs. 9.8%; p<0.001); diabetes complications (79.9% vs. 5.9%; p<0.001); and provided re-referral criteria (89.3% vs. 15.7%; p<0.001). Dictation time did not differ between formats. Transcription time (20:65 min vs. 13:45 min; p<0.01) and word count (502 words vs. 292 words; p<0.001) were higher with the template.

Conclusions

The use of a structured discharge letter template improved the content and quality of discharge letters dictated by specialists. Primary care physicians were more consistently provided with valued information and given criteria for re-referral.