Discharge Summary Writer

When to Use This Skill

Use when a clinician needs a comprehensive discharge summary document compiled from the patient's hospital course in FHIR.

Clinical Workflow

1. Use fhir_search to retrieve the Encounter (admission date, discharge date, reason, attending)
2. Use fhir_read to retrieve Patient demographics
3. Use fhir_search to pull Condition resources: admitting diagnosis, discharge diagnoses, complications
4. Use fhir_search to pull Procedure resources performed during the hospitalization
5. Use fhir_search to pull active MedicationRequest for discharge medications; compare against admission medications for reconciliation summary
6. Use fhir_search to pull key Observation results (admission labs, discharge labs, significant findings)
7. Use fhir_search to pull ServiceRequest resources for pending results and referrals
8. Use fhir_search to pull scheduled Appointments for follow-up
9. Assemble discharge summary: demographics, admission/discharge dates, admitting diagnosis, hospital course, procedures, discharge diagnoses, discharge medications, follow-up, pending results, patient instructions
10. Use fhir_create to persist as DocumentReference (LOINC 18842-5)

FHIR Resources

• Encounter -- Admission/discharge dates, reason, attending
• Patient -- Demographics
• Condition -- Admitting and discharge diagnoses
• Procedure -- Inpatient procedures
• MedicationRequest -- Discharge medications
• Observation -- Key lab results
• Appointment -- Follow-up appointments
• ServiceRequest -- Pending results, referrals
• DocumentReference -- Output: discharge summary

FHIR Query Examples

Pull Encounter

fhir_read(resourceType="Encounter", id="[encounter-id]")

Pull Procedures During Admission

fhir_search(resourceType="Procedure", queryParams="patient=[patient-id]&encounter=[encounter-id]")

Clinical Guidelines

• CMS Conditions of Participation require discharge summary within 30 days
• Joint Commission: discharge summary must include reason for admission, significant findings, procedures, discharge condition, discharge medications, follow-up instructions, pending results
• TJC NPSG.02.03.01: communicate pending test results to outpatient provider

Interpretation Guide

• Hospital course: narrative summary of key events, procedures, complications, and clinical response to treatment
• Discharge medications: full list with dose, frequency, route; highlight NEW medications and CHANGED medications vs pre-admission
• Pending results: list any results not yet available at discharge with responsible provider for follow-up
• Follow-up: specific provider names, dates, and purpose
• Patient instructions: diagnosis-specific education, activity restrictions, warning signs for ED return, diet modifications

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges