A Closed-Loop Audit of Electronic Discharge Summary Completeness and Safety Netting at Queen Alia Military Hospital...

Background Safe discharge from the hospital is a critical component of patient safety and affects continuity of care. Following discharge, surgical patients remain at risk of developing some complications and may be uncertain about their expected recovery. Clear, structured discharge information will help them understand the post-discharge pathway, recognize warning symptoms, and seek timely medical review. Safety netting advice is, therefore, important and essential in reducing preventable harm and avoidable readmissions. This study aimed to enhance patient safety and continuity of care at Queen Alia Military Hospital (QAMH) by improving the quality of electronic surgical discharge summaries, with a specific focus on safety netting. The objectives included assessing baseline completeness of 100 summaries via a 12-parameter checklist; identifying clinical and systemic barriers through a resident survey; evaluating the impact of educational workshops and standardized templates via a 106-record re-audit; and determining the prevalence of safety-netting gaps regarding red-flag symptoms and pending histopathology results across both audit cycles. Methodology A prospective clinical audit loop was conducted by utilizing retrospective electronic record reviews for data collection at QAMH by evaluating the completeness of surgical discharge summaries using a 12-parameter checklist. Following a baseline audit of 100 consecutive discharges (December 2025 to January 2026), a multimodal intervention was implemented in February 2026, comprising resident educational workshops, standardized electronic templates, and dedicated documentation time. A resident survey (n = 15) identified systemic barriers, primarily time pressure and lack of training. A re-audit of 106 records (March 2026) was conducted to measure improvement. Data were analyzed via descriptive statistics and Fisher's exact test, with inter-rater reliability ensured by independent specialist review. Results In a review of 100 adult surgical discharge summaries, overall completeness was moderate, with most summaries documenting only 5-7 out of 12 required items. Very few reached high completeness (8-9 items), and none included key safety-netting information such as red-flag symptoms, clear advice on when to seek help, or pending histopathology results. Statistical analysis showed that some sections tended to be completed together, such as final diagnosis with discharge condition, and procedures with discharge medications. However, other areas showed inconsistent or uneven documentation, with hospital course and physical assessment often missing when other sections were well documented, highlighting variability in how different parts of discharge summaries are completed. The re-audit demonstrated a substantial shift in documentation practices, with mean completeness rising to 77.04%, with core clinical reporting exceeding 90% compliance. Conclusions The implementation of clinical audit loops successfully standardized the reporting of objective clinical data, leading to a significant increase in the quality of discharge summaries. The dramatic rise in documented physical assessments and test results suggests that previous interventions effectively integrated these requirements into the clinical workflow. Nevertheless, a safety-netting gap persists. Future quality improvement cycles should prioritize the inclusion of patient-centered instructions.