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Document compiled by a Medical Officer or Resident upon patient’s discharge Contains patient’s medical condition, vital investigation results, course of treatment and follow-up actions Vetted by a senior medical team to ensure the information provided is accurate Mode of effective communication between two or more institutions, particularly in time- critical situations RESULTS A survey was conducted to understand the reasons for doctors not vetting the HIDS. An EPIC project was embarked. PDCA cycles were done for the interventions. Interventions implemented: - Timely SMS and email reminders were sent. - Templates on how to reduce the time taken to vet were circulated with the reminders. - Sharing sessions to highlight the importance of vetting and how to vet effectively were conducted. The compliance rate and number of days taken to vet the HIDS were reflected in the individual doctors’ performance reports since 2012. Automated extraction of the monthly vetting data from the HIDS system was developed to monitor the compliance rate. The percentage of inpatient discharge summaries vetted within 2 weeks was selected to be part of NHCS Clinical Quality Indicators. Doctors from each department were assigned as champions to improve the performance from 2013. Regular feedback sessions with the champions were held to understand any challenges and to discuss possible solutions that will ease the vetting process. Vetting rates was monitored weekly and regular review of past discharge summaries was performed to ensure all summaries have been vetted. Email reminders were continued to be sent and the vetting performance data was also regularly updated at department meetings. In 2015, vetting rights were granted to CTS Senior Residents to assist with the vetting process as well. Apr 15: Vetting rights granted to CTS Senior Residents. Aug 14: Regular review of past summaries Jul 13: CVM dept. adopted new ward-based consultant system. Apr 13: Champions assigned. Jun 12: Vetting data included in doctor’s reports. The project initiatives were focused on creating awareness and simplified summary templates. Owing to the implemented initiatives, the percentage of summaries vetted rose from 3.2% to above 80%. The average number of days taken to vet discharge summaries also dropped to within 5 days. T Meerra, NHCS A/Prof. Kenny Sin Yoong Kong , NHCS A/Prof. Aaron Wong Sung Lung, NHCS To Enhance the Process of Vetting Inpatient Discharge Summaries for Improved Compliance and Effectively Better Patient Care Outcomes OBJECTIVE TO IMPROVE THE PERCENTAGE OF HIDS VETTED WITHIN 2 WEEKS ABOVE 70% To examine the factors that impede the vetting of the electronic Hospital Inpatient Discharge Summaries (HIDS) Project team involved the respective department heads, department champions, quality assurance staff and IT staff. BACKGROUND When this initiative was first projected in July 2011, the percentage of vetted HIDS in NHCS was only 3.2%. 92% of the doctors were unaware that they had to vet the summaries 72% found them complicated to read WHAT IS THE IMPORTANCE OF HIDS? METHODOLOGY 1 2 3 4 5 6 7 8 9 10 11 0% 20% 40% 60% 80% 100% Do not know that we have to vet No time to vet Do not know how to vet More important things to do Not sure 92% 5% 1% 1% 1% Why are you not vetting the discharge summaries? Initiatives: Integration of fixed summary templates in the electronic HIDS system. Doctors can create a customized patient list in HIDS. SUSTAINING THE IMPROVEMENT The implementation of several improvement initiatives resulted in the gradually increase of the annual mean vetting rate to 36%, 69%, 75% and 78% in 2012, 2013, 2014 and 2015 respectively. The indicator was selected to be part of NHCS Clinical Quality Indicators from FY 2013 – 2016 and had consistently met the set stretch values each year. Year Mean Target Stretch 2013 69.4% 41.3% 43.0% 2014 74.9% 52.6% 62.6% 2015 78.1% 69.0% 74.0% CONCLUSION Overall, the project has successfully initiated a change in the culture of vetting discharge summaries amongst doctors in NHCS. It has now become a part of daily routine. The main challenge of this project was sustaining the improved performance. However, the key to overcoming this challenge was consistent data trending and regular feedback from the end users. This coupled with the support from the heads of department and the hospital management, the team was able to sustain the improved compliance rate over the last few years. 3.2% to 78% Special Acknowledgement to: A/Prof. Lim Soo Teik, Dr. Kenneth Guo, Dr. Ang Chin Yong, Dr. Chua Kim Chai, Ms. Vasantha Gopal, Ms. Angeline Yong, Ms. Chang Wei Ru, Ms. Tan Geok Mui, Mr. Victor Effendie and Mr. Chai Sze Chun. PROBLEM : DOCTORS WERE UNAWARE OF THEIR VETTING DUTIES From Decline in vetting rates in CTS from June to December 2014. Department champion had feedback that SR could also help with the vetting. In April 2015, vetting rights were granted to CTS SRs. Policy on the job description for CTS SRs included vetting of discharge summaries. Vetting rate has been well above 70% since the implementation. Weekly monitoring of vetting rates Pending summaries list were emailed to individual consultants. Vetting template guides were circulated. Champions proactively followed up with their department doctors. 24.4% to 76.9% Initiatives:
