Outpatient Discharge Summaries

[hebel]

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If not mandated by some accrediting body or your systems policies, do you consider discharge summaries when a patient is no longer following with your outpatient clinic to be the standard of care?

Would just documenting that they are being discharged from your clinic due to *** circumstances in your final progress note be enough?

 

[Sushirolls]

I don't consider it a standard of care.

But I frequently send people letters electronically and in mail saying hey are you in or out? schedule up in next 30 days or we're closing you at.
But going the length of doing a discharge summary and documenting the course of care and trials and ups and downs, etc as though it were an inpatient stay, ain't no body got time for that.

 

[comp1]

Not only is it not standard of care...I've literally never seen it.

 

[hebel]

Not only is it not standard of care...I've literally never seen it.

Lol, good to know. I used to work for a nanny state organization, whose mental health department required them.

 

[Sushirolls]

I've seen it once from a larger therapist group.
I've seen one masters level therapist do them out of extreme paranoia of being sued.

 

[splik]

My department required it and I also had to do termination summaries as a resident. It is not the standard of care but it is very helpful for a number of reasons both clinically and medicolegally. It does not take me long to do them

 

[Mass Effect]

Some residencies require them. I've never done one, but I always tell myself I will. I think if you have the time it will help their next psychiatrist whether that person is in your system to another system.

 

[calvnandhobbs68]

Some residencies require them. I've never done one, but I always tell myself I will. I think if you have the time it will help their next psychiatrist whether that person is in your system to another system.

Idk I feel like it’d be more helpful to pick up the phone and talk to the other psychiatrist for 10 minutes. I tend to get a better sense of someone’s history by talking to someone directly, esp if it’s someone that’s been seen for years. Things like “hey this guy always showed up late to appointments and don’t be surprised if he asks you for ativan sometime soon” or “we’ve tried a ton of stuff on this patient and this is as stable as we’ve gotten them” are hard to put in a letter. Also probably saves time compared to having to type out a discharge summary.

But all of this is relatively rare lol….best I usually get is a first and last note from medical records.

 

[Mass Effect]

Idk I feel like it’d be more helpful to pick up the phone and talk to the other psychiatrist for 10 minutes. I tend to get a better sense of someone’s history by talking to someone directly, esp if it’s someone that’s been seen for years. Things like “hey this guy always showed up late to appointments and don’t be surprised if he asks you for ativan sometime soon” or “we’ve tried a ton of stuff on this patient and this is as stable as we’ve gotten them” are hard to put in a letter. Also probably saves time compared to having to type out a discharge summary.

But all of this is relatively rare lol….best I usually get is a first and last note from medical records.

If you can talk to them, that's ideal. But usually you won't be able to talk the previous provider. I had a patient come in with a d/c summary that was incredible. The psychiatrist had known him for 25 years and was retiring. I had it scanned and put in the chart and still reference it from time to time if my treatment isn't working or if I need to remind myself what's been tried in the past or social hx details.

 

[hamstergang]

I keep a running treatment summary in each progress note for most of my patients. This way, I can provide my latest note and maybe the initial note instead of the whole chart or having to put together a discharge summary at the end of treatment. Plus, the ongoing summary helps me remember what we did, when, and why.

 

[hallowmann]

I keep a running treatment summary in each progress note for most of my patients. This way, I can provide my latest note and maybe the initial note instead of the whole chart or having to put together a discharge summary at the end of treatment. Plus, the ongoing summary helps me remember what we did, when, and why.

This is ultimately what I do as well. I keep a running treatment list, an updated past psych hx, and if it's pertinent update the formulation, as treatments failures or successes may push for a reevaluation or clarification of the diagnosis. This way I rarely have to look past the last note (and maybe the intake) to remind myself why I did or did not do something. Of course it also helps others, but I do it more for my own poor memory than anything else.

 

[tr]

I don't think it's at all typical but I'm consulting for a private specialty outpt clinic that is very intentional about who is in active treatment or not. When patients haven't shown up for a few months they send letters/notes, and have a 'discharge note' template form that is very short (usually 1-2 sentences plus cut-and-paste of A/P from last f/u note) but documents the basics of why the patient is no longer actively in treatment with the clinic. I think it's actually a very smart and organized approach.

 

[clozareal]

My residency required it but my fellowship doesn't. It's causing problems with figuring out who is in active treatment, who isn't, and how big the panels actually are. For example, a patient who saw a fellow a year or two ago calling for a follow-up appointment and being placed on my schedule as a routine follow-up rather than going back on the waitlist for an intake, especially when some specialty clinic appointments waitlists are months long although this is a reason why they want to stay on the panel instead of having to be discharged from the outpatient clinic.

I also wonder about the medicolegal aspects of it, particularly around when a doctor-patient relationship starts and ends.