---
name: discharge-summary-structure
description: "Use when writing a hospital discharge summary from an admission's facts — emits the six required sections in a fixed order (admission & discharge diagnoses, hospital course, procedures, discharge medications with every change flagged, pending results, and itemized follow-up), never silently dropping an empty section, instead of a free-form clinical narrative. Do NOT use for lab-unit harmonization, coding the visit, or an outpatient progress note."
metadata:
  decimalai-skill-id: "dcb511ac-0f76-424a-8d98-15d6e3b2ecd8"
  decimalai-version-id: "7bd31a95-94d6-4477-ac22-b6bf690018bd"
  decimalai-version: "1"
  decimalai-body-sha256: "faaad5ca1e4783b65aed4d3bc7af94b96af91c621e865660623f002006226a42"
  decimalai-name: "discharge-summary-structure"
  decimalai-format: "1"
  decimalai-invocation: "model"
  decimalai-category: "documentation"
  decimalai-source: "https://app.decimal.ai/s/discharge-summary-structure@1/SKILL.md"
---
# Discharge summary structure

A discharge summary is the handoff the next clinician actually reads. Its value comes from
being **complete and predictable**, not from prose quality. The discipline is a fixed set of
sections, in a fixed order, where the two most-omitted sections — what changed about the meds
and what is still pending — are always present, even when the answer is "nothing."

Emit these six sections, in this order, with these headings. Never reorder them and never drop
one: when a section has no content, keep the heading and write the explicit empty value shown.

1. **Admission & Discharge Diagnoses** — state *both*. The admitting (working) diagnosis and the
   final discharge diagnosis, even when they are the same. When the diagnosis was refined or
   changed during the stay, both must appear so the reader sees the evolution.
2. **Hospital Course** — a brief narrative of what happened between admission and discharge: the
   presenting problem, the key events, and how the patient responded. This is the one narrative
   section; keep it factual and chronological.
3. **Procedures** — every procedure, operation, or significant intervention performed during the
   stay. If none were performed, keep the heading and write **"None."** — do not omit it.
4. **Discharge Medications** — the full list the patient leaves on, and for each medication a
   **change flag relative to what they took before admission**:
   - **NEW** — started this admission.
   - **CHANGED** — same drug, different dose/frequency/route (state the old → new).
   - **STOPPED** — a pre-admission medication discontinued (list it explicitly as stopped; do
     not just leave it off the list).
   - **CONTINUED** — unchanged from before admission.
   Every med carries exactly one flag. An unchanged home medication is **CONTINUED**, never
   flagged as changed. A discontinued medication is called out as **STOPPED**, not silently
   dropped — the omission is the error the flag exists to prevent.
5. **Pending Results** — every test, culture, pathology, or study whose result was **not back at
   discharge**, each with who is responsible for following it up. If nothing is pending, keep the
   heading and write **"None pending."** — this section is omitted more than any other, so it is
   always present.
6. **Follow-up** — an **explicit, itemized list** of action items: each appointment or task with
   *who* (specialty/clinic) and *when* (timeframe). Follow-up is never buried inside the hospital
   course narrative; it is its own enumerated list a reader can act on line by line.

## The two disciplines that carry the value

- **Flag every medication change.** A discharge med list without change flags forces the next
  clinician to diff two lists by hand. New, changed, and stopped are each called out; a stopped
  drug is stated as stopped rather than dropped. This is medication reconciliation, and it is the
  most safety-critical part of the summary.
- **Never let an empty section disappear.** "No procedures," "nothing pending," and "no
  medication changes" are *information*. Writing the heading with an explicit empty value tells
  the reader you checked; silently omitting the section tells them nothing — and reads as an
  oversight. Presence of all six headings is the contract.

## Worked example (abbreviated)

```
Admission & Discharge Diagnoses:
  Admission: chest pain, rule out ACS.
  Discharge: NSTEMI.
Hospital Course:
  Presented with exertional chest pain; troponin rose; treated medically and stabilized...
Procedures:
  Coronary angiography with drug-eluting stent to the LAD.
Discharge Medications:
  - Aspirin 81 mg daily — CONTINUED
  - Ticagrelor 90 mg BID — NEW
  - Metoprolol 50 mg BID — CHANGED (was 25 mg daily)
  - Ibuprofen — STOPPED (bleeding risk on dual antiplatelet)
Pending Results:
  - Lipid panel drawn on discharge day — PCP to review at follow-up.
Follow-up:
  - Cardiology, within 1–2 weeks.
  - Primary care, within 1 week to review pending lipids.
```

If there were no procedures, the Procedures line would read `None.`; if nothing were pending,
Pending Results would read `None pending.` — the headings stay either way.