1. Objective To develop and implement a quality improvement program composed of a discharge summary curriculum and an objective discharge summary scoring tool for feedback purposes with the goal of improving discharge summary quality and timeliness. Hospitalized older adults are at particularly high risk for new/worsening symptoms, medication related problems, and other adverse events after hospital discharge.(1) Nationally, 19.6% of hospitalized Medicare patients are readmitted within 30 days, with even higher rates for nursing home residents. Excess costs for readmissions are estimated at $17.4 billion/year.(2-3) Communication between inpatient and outpatient care providers is poor with direct communication occurring only 3-20% of the time. Discharge summaries are often late with only 12- 34% available at the time of first follow up appointment.(4) Prior clinical trials have reported the effectiveness of individual feedback to improve discharge summary quality, but there are few reports of successful QI programs in this area.(5) However, little is known regarding the value of team-based feedback in teaching settings for improving discharge summary quality. Background As part of our Aging Q 3 Program funded by the D.W. Reynolds Foundation, our multidisciplinary team adapted and extensively refined an objective discharge summary scoring instrument that featured a weighted list of 13 elements deemed critical for high quality discharge summaries.(6) (Figure 1) Internal Medicine residents were presented a coordinated discharge summary curriculum that included didactic lectures, academic detailing, morning report presentations, and distribution of discharge summary template pocket cards. (Figure 2) ALL interns reviewed at least 3 of their own previously dictated discharge summaries with Aging Q 3 faculty. Feedback was provided, and faculty/intern agreed on a “Prescription for Improvement.” In addition, general medicine teams rotating on the general medicine inpatient service received team- based feedback on summaries of patients recently discharged from their service (~1/week). Methods Preliminary Results Conclusions An integrated discharge summary curriculum combined with individualized team-based feedback can improve objective discharge summary scores. Team-based feedback provided on a weekly basis to inpatient teams is feasible. Ongoing analysis in progress regarding the effect of team-based feedback on discharge summaries produced by upper-level resident physicians. Individual and Team-based Feedback to Improve Discharge Summary Quality for Hospitalized Elders R. Neal Axon, MD, MSCR 1.2 ; Fletcher T. Penney, MD 2 ; Justin E. Marsden 2 ; Patty J. Iverson, MA 2 ; Jane Zapka, ScD 2 ; Patrick D. Mauldin, PhD 2 ; Kimberly S. Davis, MD 2 ; Yumin Zhao, PhD 2 ; Lauren Angotti, MD 2 ; William P. Moran, MD 2 1. Ralph H. Johnson VAMC 2. The Medical University of South Carolina References 1. Snow V, Beck D, Budnitz T, Miller DC, Potter J, Wears RL, et al. Transitions of Care Consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College Of Emergency Physicians, and Society for Academic Emergency Medicine. Journal of Hospital Medicine. 2009;4(6):364-70. 2. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among Patients in the Medicare Fee-for-Service Program. N Engl J Med. 2009;360(14):1418-28. 3. Mor V, Intrator O, Feng Z, Grabowski DC. The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood). 2010;29(1):57-64. 4. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in Communication and Information Transfer Between Hospital- Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care. JAMA. 2007;297(8):831-41. 5. Myers JS, Jaipaul CK, Kogan JR, Krekun S, Bellini LM, Shea JA. Are Discharge Summaries Teachable? The Effects of a Discharge Summary Curriculum on the Quality of Discharge Summaries in an Internal Medicine Residency Program. Academic Medicine. 2006;81(10):S5-S8 10.1097/01.ACM.0000236516.63055.8b. 6. Coit MH, Katz JT, McMahon GT. The Effect of Workload Reduction on the Quality of Residents' Discharge Summaries. J Gen Intern Med. 2010. Over the 3 month QI project, 100% of Interns received discharge summary feedback 12 of 12 inpatient teams received team-based feedback during the intervention period. Overall, 77.2% of residents received individualized feedback, team-based feedback, or academic detailing exercise to practice evaluating discharge summaries. For Interns- paired means for discharge summary grades (out of 100 points) improved from 75.3% ± 8.1 or with 95% confidence interval 75.3 (72.6, 78.1) to 83.0% ± 6.1 or with 95% confidence interval 83.0 (80.9, 85.0) (p =.0001) (Letter grade increase from C to B). Post test results showed an overall Resident confidence increase in ability to construct a discharge summary which meets standard quality criteria (p =.0006). Post test results also showed an overall Resident confidence increase in ability to critique a discharge summary according to standard quality criteria (p = <.0001). Figure 1: Figure 2: