Hospital admissions are part of a continuum of care rather than isolated events. Because multiple caregivers are often involved, effective communication with the family and caregivers is essential to assure continuity after discharge. In a children's hospital where >90% of all orders are written by residents, we required completion of a set of pre-printed discharge orders individualized to the particular patient and diagnosis. Required items included: disposition, condition, primary and secondary diagnosis, operations and major procedures, approval by the attending physician, whether the discharge plan was discussed with the PCP (with the option of faxing discharge orders to the PCP), who would dictate the final discharge summary, whether the discharge plan was discussed with the parent or guardian, consideration of immunizations that might be given prior to discharge, follow-up plans, diet, activity, and medications. We retrospectively analyzed completion of these elements in the patient record for two periods: June - July, 1994 (before standard orders), June - July, 1995 (after). Outcome variables were documented if mentioned in one of the following: orders, nursing discharge note, resident, or attending discharge note, or discharge summary. Standardized, pre-printed discharge orders increased resident compliance with desired outcomes in both surgical and pediatric medicine groups. This order format is simple to implement, easy to audit, and an effective teaching tool.Table

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