Implementing discharge summary documentation: a quality improvement initiative in a Nigerian hospital

Discharge summaries (DS) are essential for ensuring safe and effective transitions from inpatient to outpatient care, yet completion rates are often suboptimal in low-resource settings. This quality improvement project (QIP) was undertaken in the General Surgery and Neurosurgery units of the Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Nigeria, to increase DS completion to at least 50% within 12 weeks. Using the Plan–Do–Study–Act (PDSA) model, baseline performance was established via a 3-month retrospective audit, revealing DS completion rates of 0% (0/56) in General Surgery and 33% (7/21) in Neurosurgery, with an overall rate of 9% (7/77). A survey of surgical trainees and house officers identified poor knowledge of DS practice and the absence of a standardised template as key barriers.

Interventions included DS training at induction, dissemination of prestructured templates, deployment of visual management tools and appointment of unit-based DS champions. Change ideas were tested in 1-week to 2-week PDSA cycles with continuous monitoring of process and outcome measures. Data were analysed using IBM SPSS Statistics V.25, and significance was assessed via χ ² testing.

Following implementation, DS completion rates improved to 82% (68/83), consistently surpassing the target and reaching 100% during some cycles (χ ² =85.35, p<0.0001). Median daily discharges were 2.0 in General Surgery and 1.5 in Neurosurgery, with median completion rates of 93.4% and 100%, respectively. These improvements reflected the effectiveness of targeted training, standardised documentation and role designation in addressing systemic and behavioural barriers.

This QIP demonstrates that structured, context-appropriate interventions can substantially and sustainably increase DS completion rates in resource-limited settings, thereby strengthening continuity of care. Future directions include scaling these strategies to other departments, integrating electronic DS systems and embedding routine audits to sustain compliance.