A clinical audit of discharge summaries: conformity to set guidelines in the department of psychiatry and mental health at Mmuhimbili national hospital Dar es Salaam Tanzania.

Abstract

Background: Patients‟ records are the most basic clinical tools that are required in every consultation. Discharge summary as a document collect patient‟s information about inpatients care. The primary function is to support continuity of care as the patient returns to next health provider. Improvement in the care of mentally ill patients may be enhanced by improving discharge summaries writing in terms of its contents and timing. There is paucity of data that shows deficits in writing discharge summaries in the developing countries including Tanzania. Systematically reviewing and auditing care against explicit criteria and set of guidelines is a quality improvement process that seeks to improve the patient care and outcomes. Implementing best-practice guidelines for managing mental illnesses is demanding but rewarding. Identifying deficits in writing discharge summaries as done in this clinical audit is pertinent to ensure improvement of quality of patients‟ care and good outcome. Objective: To determine the extent to which discharge summaries conform to the guideline for best practice of mental health service delivery in Department of Psychiatry and Mental Health at Muhimbili National Hospital (MNH) Study site and design: A cross sectional retrospective, clinical audit of a discharge summary looking at the contents and timing of discharge summary writing was conducted in the Department of Psychiatry and Mental Health at the MNH Methods: A chart review of all new admission discharge summaries in 2010 was done. A total of 200 planned discharge summaries were reviewed. Data was collected using a discharge check list that was extracted from guideline for best practice of mental health service delivery at MNH. The conformity level was considered at a cutoff point of ≥88% of overall contents of discharge summary as from other studies.The results were tabulated, grouped and statistically analyzed using the descriptive statistics reported as proportions, frequencies, and comparative statistic using Pearson Chi square/fisher‟s exact test to detect whether there is a significant statistical difference between different categorical variables. The P value of less than or equal to 0.05 was considered statistically significant for differences examined. Results: This study found that, of 200 systematically selected planned discharge summaries; “documented review with patient diagnosis” 100% (n=200) and “documented date of return to outpatient clinic” 90.82% (n=178) are the only two items that were in conformity with standard discharge guidelines. The other ten items studied were found not conforming to standard guidelines. Again to determine the timing of discharge summary writing, the results of this study have identified that about 93% (n=186) of the discharge summaries were written within two weeks of admission while others were before/after two weeks of admission. Conclusion and Recommendations: Implementing good clinical practice in metal health in the department of psychiatry and mental health at MNH remains a challenge for clinicians. Discharging clinician‟s should follow standard guidelines for good clinical practice as agreed by the department to reduce areas of deficits in clinical practice in mental health. Interventions are needed to ensure clinicians are conforming to the standard guidelines when writing discharge summaries.