St. Aldric Hospital

The business

St. Aldric is a 640-bed teaching hospital in the United States with about 2,900 discharges a month. Every discharge needs a discharge summary: the hospital course, diagnoses, procedures, medications at discharge, results still pending, and follow-up instructions for the patient and their primary care doctor.

Measured baseline

• Physicians spend about 2.1 hours a day on documentation; a discharge summary takes 35 minutes on average.
• The coding team returns 12% of summaries for missing or unclear information, which delays billing by an average of 4 days.
• 1 in 7 discharges is delayed past noon because the summary is not signed.

How a discharge summary is written today

1. The physician reads the stay's notes in the electronic health record (EHR): admission note, daily progress notes, consult notes, procedure reports.
2. They write the hospital course and list diagnoses and procedures.
3. They copy the discharge medication list from the pharmacist's medication reconciliation.
4. They check for results that are still pending.
5. They write follow-up instructions and book follow-up appointments.
6. They sign the summary, which is sent to the patient's primary care doctor.
7. Coders assign diagnosis and procedure codes from the signed summary.

Systems

Data and regulation

• Everything in a summary is protected health information under HIPAA. Any vendor that processes it needs a Business Associate Agreement (BAA).
• The hospital's cloud is AWS, with a BAA in place; data must stay in the United States.
• Clinical documents and their audit trail are kept for 6 years.
• A physician must review and sign every summary; nothing is sent unsigned. The system must not suggest medication changes.

Size of the inputs

• The notes for a typical stay come to about 30,000 tokens; long stays reach 140,000 tokens (95th percentile).
• A finished summary is about 1,500 tokens.

People