Implementation of a New Discharge Card in the Department of Internal Medicine at Atbara Teaching Hospital

TL;DR

A new discharge card was implemented in a Sudanese hospital to improve patient safety and documentation during hospital to home transitions.

Contribution

A standardized discharge card based on HIQA standards was developed and implemented in a low-resource setting to improve documentation completeness.

Findings

Significant improvements were observed in allergy recording, contact information, and specialist referrals after implementation.

Documentation of patient name, age, diagnosis, and clinical summary remained consistently high.

Persistent deficiencies remained for date of birth and professional role documentation, suggesting areas for further improvement.

Abstract

Introduction: Effective discharge documentation is essential for safe transitions from hospital to community care. The Health Information and Quality Authority (HIQA) outlines seven core data categories for patient discharge summaries. In low-resource settings, structured formats have been shown to improve completeness, clarity, and patient safety. This quality improvement project (QIP) aimed to develop and implement a standardized discharge card in the Internal Medicine Department of Atbara Teaching Hospital, Sudan, adapted from HIQA standards.

Methodology: The project followed a two-cycle audit (April-August 2025). In the first cycle, 50 discharge records were reviewed to identify gaps. Records were randomly selected from the pool of available patient files, and auditing was conducted by three physicians not directly involved in patient care during the study period. A standardized discharge card was co-developed with staff, including essential demographic, clinical, and follow-up details. Training was provided, and the tool was implemented. In the second cycle, 40 discharge records were audited. Data was analyzed using chi-square tests to compare pre- and post-intervention documentation rates.

Results: Significant improvements were observed in gender documentation (46.8%→100%, P < 0.001), allergy recording (12.9%→88.3%, P < 0.001), telephone number (0%→36.6%, P < 0.001), address (1.6%→43.0%, P < 0.001), referral to specialist (0%→35.0%, P < 0.001), and referrer details (32.3%→55.0%, P = 0.028). High compliance was maintained for the patient’s name, age, primary diagnosis, and clinical summary. These gains are clinically meaningful, as improved allergy and contact documentation directly support patient safety and follow-up. Persistent deficiencies remained for date of birth (0%→5.0%, P = 0.110) and professional role documentation (40.3%→50.0%, P = 0.343), likely reflecting reliance on age notation and limited emphasis on role identification.

Conclusion: The standardized discharge card significantly improved documentation in key patient safety domains. Sustained gains require ongoing staff training and regular audits. This model may also be generalizable to other departments and hospitals in low-resource settings.

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