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Hospital Discharge Studies Summary Section

Template ID: 2.16.840.1.113883.10.20.22.2.16 Version: No specific version extension Badge: Hospital Section

Overview

The Hospital Discharge Studies Summary Section records the results of observations generated by laboratories, imaging procedures, and other diagnostic studies performed at or near the time of discharge. This section provides a summary of key diagnostic findings relevant to the patient's discharge, including laboratory tests, imaging studies, and other procedures that inform post-discharge care.

Clinical Purpose and Context

The Hospital Discharge Studies Summary documents: - Laboratory test results at discharge (hematology, chemistry, etc.) - Imaging procedure results (X-ray, CT, MRI, ultrasound, etc.) - Diagnostic procedure findings (echocardiography, nuclear medicine, etc.) - Pathology results relevant to discharge - Other diagnostic observations performed during hospitalization

This section helps receiving providers understand the patient's status at discharge and guides ongoing care and follow-up testing needs.

When to Include

The Hospital Discharge Studies Summary Section is typically included in: - Discharge Summaries (primary use case) - Transfer Summaries - Continuity of Care Documents for hospitalized patients

This section is particularly valuable when discharge test results differ from admission values or when they inform follow-up care decisions.

Template Details

Official OID

  • Root: 2.16.840.1.113883.10.20.22.2.16
  • Extension: None specified

Conformance Level

  • Conformance: MAY (Optional)
  • Section Code: 11493-4 (LOINC - "Hospital Discharge Studies Summary")

Cardinality

  • Section: 0..1 (Optional)
  • Entries: 0..* (Result Organizer entries grouping related studies)
  • Result Organizer (V3): 2.16.840.1.113883.10.20.22.4.1:2015-08-01
  • Result Observation (V3): 2.16.840.1.113883.10.20.22.4.2:2015-08-01

Protocol Requirements

The section uses two protocols: one for individual studies and one for study organizers (panels).

DischargeStudyObservationProtocol

Each individual study observation must provide:

Property Type Description
study_name str Name of the study/test
study_code str LOINC code for the study
value str Measured value (numeric or text)
status str Status: 'completed', 'preliminary', 'final'
effective_time date\|datetime When study was performed

Optional Study Properties

Property Type Description
unit Optional[str] Unit of measurement
value_type Optional[str] 'PQ', 'CD', or 'ST'
interpretation Optional[str] 'N' (normal), 'A' (abnormal), etc.
reference_range_low Optional[str] Lower bound of reference range
reference_range_high Optional[str] Upper bound of reference range
reference_range_unit Optional[str] Unit for reference range

DischargeStudyOrganizerProtocol

Study organizers (panels) must provide:

Property Type Description
study_panel_name str Name of the panel
study_panel_code str LOINC code for the panel
status str Status of the organizer
effective_time date\|datetime When panel was collected/performed
studies Sequence List of study observations in panel

Code Example

Here's a complete working example using ccdakit to create a Hospital Discharge Studies Summary Section:

from datetime import datetime
from ccdakit.builders.sections.discharge_studies import HospitalDischargeStudiesSummarySection
from ccdakit.core.base import CDAVersion

# Define individual study observations
class StudyObservation:
    def __init__(self, name, code, value, unit=None, interpretation=None,
                 ref_low=None, ref_high=None, effective_time=None):
        self.study_name = name
        self.study_code = code
        self.value = value
        self.unit = unit
        self.status = "final"
        self.effective_time = effective_time or datetime(2024, 10, 20, 8, 0)
        self.value_type = "PQ" if unit else "ST"
        self.interpretation = interpretation
        self.reference_range_low = ref_low
        self.reference_range_high = ref_high
        self.reference_range_unit = unit

# Define study organizer (panel)
class StudyOrganizer:
    def __init__(self, panel_name, panel_code, studies, effective_time):
        self.study_panel_name = panel_name
        self.study_panel_code = panel_code
        self.status = "completed"
        self.effective_time = effective_time
        self.studies = studies

# Create Complete Blood Count panel
cbc_studies = [
    StudyObservation(
        name="Hemoglobin",
        code="718-7",  # LOINC
        value="13.5",
        unit="g/dL",
        interpretation="N",
        ref_low="13.0",
        ref_high="17.0"
    ),
    StudyObservation(
        name="White Blood Cell Count",
        code="6690-2",  # LOINC
        value="8.2",
        unit="10*3/uL",
        interpretation="N",
        ref_low="4.5",
        ref_high="11.0"
    ),
    StudyObservation(
        name="Platelet Count",
        code="777-3",  # LOINC
        value="220",
        unit="10*3/uL",
        interpretation="N",
        ref_low="150",
        ref_high="400"
    )
]

cbc_organizer = StudyOrganizer(
    panel_name="Complete Blood Count",
    panel_code="58410-2",  # LOINC for CBC panel
    studies=cbc_studies,
    effective_time=datetime(2024, 10, 20, 8, 0)
)

# Create Metabolic Panel
metabolic_studies = [
    StudyObservation(
        name="Glucose",
        code="2345-7",  # LOINC
        value="95",
        unit="mg/dL",
        interpretation="N",
        ref_low="70",
        ref_high="100"
    ),
    StudyObservation(
        name="Creatinine",
        code="2160-0",  # LOINC
        value="1.1",
        unit="mg/dL",
        interpretation="N",
        ref_low="0.7",
        ref_high="1.3"
    ),
    StudyObservation(
        name="Sodium",
        code="2951-2",  # LOINC
        value="140",
        unit="mmol/L",
        interpretation="N",
        ref_low="136",
        ref_high="145"
    ),
    StudyObservation(
        name="Potassium",
        code="2823-3",  # LOINC
        value="4.2",
        unit="mmol/L",
        interpretation="N",
        ref_low="3.5",
        ref_high="5.1"
    )
]

metabolic_organizer = StudyOrganizer(
    panel_name="Basic Metabolic Panel",
    panel_code="51990-0",  # LOINC
    studies=metabolic_studies,
    effective_time=datetime(2024, 10, 20, 8, 0)
)

# Create Chest X-Ray result
imaging_studies = [
    StudyObservation(
        name="Chest X-Ray Findings",
        code="36643-5",  # LOINC
        value="No acute cardiopulmonary process. Normal heart size. Clear lungs.",
        unit=None
    )
]

imaging_organizer = StudyOrganizer(
    panel_name="Chest X-Ray",
    panel_code="36643-5",  # LOINC
    studies=imaging_studies,
    effective_time=datetime(2024, 10, 19, 14, 30)
)

# Build the Hospital Discharge Studies Summary Section
section_builder = HospitalDischargeStudiesSummarySection(
    study_organizers=[cbc_organizer, metabolic_organizer, imaging_organizer],
    title="Hospital Discharge Studies Summary",
    version=CDAVersion.R2_1
)

# Generate XML element
section_element = section_builder.build()

# Convert to XML string (for demonstration)
from lxml import etree
xml_string = etree.tostring(section_element, pretty_print=True, encoding='unicode')
print(xml_string)

Official Reference

For complete specification details, refer to the official HL7 C-CDA R2.1 documentation: - HL7 C-CDA R2.1 Implementation Guide - Section: Hospital Discharge Studies Summary Section

Best Practices

Common Patterns

  1. Group Related Studies
  2. Use organizers (panels) to group related tests
  3. Complete Blood Count (CBC) - all blood cell counts together
  4. Basic/Comprehensive Metabolic Panel - chemistry values together

  5. Imaging by modality - all chest X-rays together

  6. Include Reference Ranges

  7. Provide normal ranges for lab values
  8. Helps interpret abnormal results
  9. Include units for reference ranges

  10. Match reference range units to value units

  11. Use Standard LOINC Codes

  12. LOINC is required for lab and diagnostic studies
  13. Use specific LOINC codes for individual tests
  14. Use panel LOINC codes for organizers

  15. Ensure codes match the actual test performed

  16. Document Interpretation

  17. Include abnormal flags when available
  18. 'N' = Normal, 'A' = Abnormal, 'H' = High, 'L' = Low
  19. Helps quickly identify concerning values
  20. Supports clinical decision-making

Validation Tips

  1. Section Code Validation
  2. Ensure section code is 11493-4 (LOINC "Hospital Discharge Studies Summary")

  3. This is automatically set by the builder

  4. Organizer Structure

  5. Each organizer contains one or more observations
  6. Use Result Organizer template

  7. Observations use Result Observation template

  8. LOINC Code Validation

  9. All study codes must be from LOINC
  10. Panel codes must be LOINC panel codes

  11. Individual test codes must be LOINC observation codes

  12. Value Type Consistency

  13. If unit is provided, use value_type="PQ" (physical quantity)
  14. For text results, use value_type="ST" (string)
  15. For coded results, use value_type="CD" (coded)

Common Pitfalls

  1. Missing Units
  2. Always include units for numeric values
  3. Units are critical for interpretation

  4. Use standardized UCUM units when possible

  5. Inconsistent Reference Ranges

  6. Reference range units must match value units
  7. Provide both low and high when available

  8. Some tests only have upper or lower limits

  9. Wrong LOINC Codes

  10. Use specific LOINC codes for exact tests
  11. Don't use generic or approximated codes

  12. Panel codes differ from individual test codes

  13. Mixing Time Precision

  14. Use datetime for timed studies (e.g., serial labs)
  15. Use date for studies where exact time isn't critical

  16. Be consistent within a panel

  17. Not Grouping Related Tests

  18. Group related tests in organizers
  19. Don't create separate organizers for each test

  20. Use standard panel groupings when applicable

  21. Missing Interpretations

  22. Include abnormal flags when available
  23. Helps receiving providers identify priorities
  24. Important for quality of information
  • Results Section: Ongoing lab and diagnostic results
  • Diagnostic Imaging Report: Detailed imaging findings
  • Discharge Diagnosis Section: Clinical context for studies
  • Plan of Treatment Section: Follow-up testing needed

Code Systems and Terminologies

Study Codes (LOINC - Required)

All study codes must use LOINC: - Laboratory Tests: LOINC codes for specific tests - Imaging Studies: LOINC codes for imaging procedures - Panels: LOINC panel codes for grouped tests

Common LOINC codes: - 58410-2 - Complete Blood Count panel - 51990-0 - Basic Metabolic Panel - 24323-8 - Comprehensive Metabolic Panel - 2951-2 - Sodium - 2823-3 - Potassium - 718-7 - Hemoglobin

Interpretation Codes

  • N - Normal
  • A - Abnormal
  • H - High (above normal range)
  • L - Low (below normal range)
  • HH - Critical high
  • LL - Critical low

Status Codes

  • completed - Study is complete
  • final - Results are final
  • preliminary - Preliminary results
  • corrected - Results have been corrected

Section Codes

  • Primary: 11493-4 - "Hospital Discharge Studies Summary" (LOINC)

Implementation Notes

Narrative Table Generation

The builder creates a comprehensive table with columns: - Study Panel (panel name, shown once per panel) - Study (individual test name) - Value - Unit - Interpretation - Reference Range - Date

Result Organizer Reuse

The section reuses the Result Organizer pattern: - Same structure as Results Section - DischargeStudyOrganizerProtocol is compatible with ResultOrganizerProtocol - Leverages existing Result builders

Panel-Based Organization

Studies are organized by panels: - Each panel becomes one organizer - Organizer contains related observations - Grouping matches clinical workflow

Value Types

Three value types are supported: - PQ (Physical Quantity): Numeric with units (e.g., "140 mg/dL") - ST (String): Text results (e.g., "Normal") - CD (Coded): Coded results using standard terminologies

Reference Ranges

Reference ranges help interpretation: - Provide context for values - May be patient-specific or population-based - Should include units - Can have only upper or lower bound

Timing Flexibility

Effective time can be date or datetime: - datetime: For precise timing (serial labs) - date: For studies where exact time isn't critical - Builder handles both formats

Integration with Discharge Summary

The Hospital Discharge Studies Summary complements: - Discharge Diagnosis: Clinical assessment - Hospital Course: Narrative of hospital stay - Discharge Medications: Based on discharge lab values - Follow-up Plans: May include repeat testing

Scope of Studies

The section includes: - Hematology: Blood counts, coagulation studies - Chemistry: Electrolytes, renal function, liver function - Serology/Virology: Infectious disease testing - Toxicology: Drug levels, poisoning tests - Microbiology: Culture results - Imaging: X-ray, CT, MRI, ultrasound findings - Cardiac: ECG, echocardiogram, stress test - Nuclear Medicine: PET, nuclear scans - Pathology: Biopsy results, surgical pathology

Discharge vs. Ongoing Results

Use Hospital Discharge Studies Summary for: - Studies performed at or near discharge - Results needed for immediate post-discharge care - Key findings that inform discharge planning

Use Results Section for: - Longitudinal lab tracking - All results during hospital stay - Comprehensive test history

Clinical Decision Support

Discharge studies inform: - Medication adjustments at discharge - Need for follow-up testing - Risk stratification for post-discharge complications - Transitions of care planning - Patient education about ongoing monitoring

LOINC Code Selection

Tips for selecting LOINC codes: - Use search.loinc.org for official codes - Be specific about specimen type (blood, urine, etc.) - Include method when relevant - Use the most specific code available - Panel codes aggregate related tests

Empty Section Handling

If no discharge studies available: 

section = HospitalDischargeStudiesSummarySection(
    study_organizers=[],
    version=CDAVersion.R2_1
)

This generates narrative: "No discharge studies available"