What to write
Key findings, including relevance to the rationale and specific aims
Particular strengths of the project
Explanation
Although often not called out with a specific subheading, the ‘summary’ of a report on healthcare improvement most often introduces and frames the ‘discussion’ section. While the first paragraph should be a focused summary of the most critical findings, the majority of the project’s results should be contained in the results section. The goal of the summary is to capture the major findings and bridge the discussion to a more nuanced exploration of those findings. Exactly where the summary section ends is far less important that how it sets up the reader to explore and reflect on the ensuing discussion.
The example below gives a clear and concise statement of the study’s strengths and distinctive features. This summary recaps quantitative findings (families called METs relatively infrequently and fewer of their calls resulted in intensive care unit (ICU) transfers), and introduces a subsequent discussion of concerns identified by families which might not be visible to clinicians, including ways in which ‘family activation of an MET may improve care without reducing MET-preventable codes outside of the ICU’.1 This conveys an important message and bridges to a discussion of the existing literature and terminology. Providing a focused summary in place of an exhaustive re-statement of project results appropriately introduces the reader to the discussion section and a more thorough description of the study’s findings and implications.
The authors go on to relate these main findings back to the nature and significance of the problem and the specific aims previously outlined in the introduction section, specifically (emphasis added) ’To evaluate the burden of family activation on the clinicians involved\…too better understand the outcome of METs, and to begin to understand why families call METs’.1
Another approach in structuring the summary component of the discussion is to succinctly link results to the relevant processes in the development of the associated interventions. This approach is illustrated by Beckett et al in a recent paper about decreasing cardiac arrests in the acute hospital setting,2 “Key to this success has been the development of a structured response to the deteriorating patient. Following the implementation of reliable EWS (early warning systems) across the AAU(Acute Admissions Unit) and ED (Emergency Department), and the recognition and response checklists, plus weekly safety meetings in the AAU at SRI(Stirling Royal Infirmary), there was an immediate fall in the number of cardiac arrests, which was sustained thereafter.”2 This linkage serves to reintroduce the reader to some of the relevant contextual elements which can subsequently be discussed in more detail as appropriate. Importantly, it also serves to frame the interpretive section of the discussion which focuses on comparison of results with findings from other publications, and further evaluating the project’s impact.
Example
In our 6-year experience with family-activated METs(Medical Emergency Teams), families uncommonly activated METs. In the most recent and highest-volume year, families called 2.3 times per month on average. As a way of comparison, the hospital had an average of 8.7 accidental code team activations per month over this time. This required an urgent response from the larger team. Family activation less commonly resulted in ICU transfer than clinician activated METs, although 24% of calls did result in transfers. This represents a subset of deteriorating patients that the clinical team may have missed. In both family-activated and clinician-activated MET calls, clinical deterioration was a common cause of MET calls. Families more consistently identified their fear that the child’s safety was at risk, a lack of response from the clinical team, and that the interaction between team and family had become dismissive. To our knowledge, this study is the largest study of family-activated METs to date, both in terms of count of calls and length of time observed. It is also the first to compare reasons for MET calls from families with matched clinician-activated calls.1
Training
The UK EQUATOR Centre runs training on how to write using reporting guidelines.
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