Physician- and Large Language Model-Generated Hospital Discharge Summaries: A Blinded, Comparative Quality and Safety Study
Authors: Williams Christopher Y.K. , Subramanian Charumathi Raghu , Ali Syed Salman , Apolinario Michael , Askin Elisabeth , Barish Peter , Cheng Monica , Deardorff W. James , Donthi Nisha , Ganeshan Smitha , Huang Owen , Kantor Molly A. , Lai Andrew R. , Manchanda Ashley , Moore Kendra A. , Muniyappa Anoop N. , Nair Geethu , Patel Prashant P. , Santhosh Lekshmi , Schneider Susan , Torres Shawn , Yukawa Michi , Hubbard Colin C. , Rosner Benjamin I. 
Published: October 2024

AbstractImportanceHigh quality discharge summaries are associated with improved patient outcomes but contribute to clinical documentation burden. Large language models (LLMs) provide an opportunity to support physicians by drafting discharge summary narratives.ObjectiveTo determine whether LLM-generated discharge summary narratives are of comparable quality and safety to those of physicians.DesignCross-sectional study.SettingUniversity of California, San Francisco.Participants100 randomly selected Inpatient Hospital Medicine encounters of 3-6 days duration between 2019-2022.ExposureBlinded evaluation of physician- and LLM-generated narratives was performed in duplicate by 22 attending physician reviewers.Main Outcomes and MeasuresNarratives were reviewed for overall quality, reviewer preference, comprehensiveness, concision, coherence, and three error types – inaccuracies, omissions, and hallucinations. Each error individually, and each narrative overall, were assigned potential harmfulness scores on a 0-7 adapted AHRQ scale.ResultsAcross 100 encounters, LLM- and physician-generated narratives were comparable in overall quality on a 1-5 Likert scale (average 3.67 [SD 0.49] vs 3.77 [SD 0.57], p=0.213) and reviewer preference (χ2 = 5.2, p=0.270). LLM-generated narratives were more concise (4.01 [SD 0.37] vs. 3.70 [SD 0.59]; p<0.001) and more coherent (4.16 [SD 0.39] vs. 4.01 [SD 0.53], p=0.019) than their physician-generated counterparts, but less comprehensive (3.72 [SD 0.58] vs. 4.13 [SD 0.58]; p<0.001). LLM-generated narratives contained more unique errors (average 2.91 [SD 2.54] errors per summary) than physician-generated narratives (1.82 [SD 1.94]). Averaged across individual errors, there was no significant difference in the potential for harm between LLM- and physician-generated narratives (1.35 [SD 1.07] vs 1.34 [SD 1.05], p=0.986). Both LLM- and physician-generated narratives had low overall potential for harm (<1 on 0-7 scale), although LLM-generated narratives scored higher than physician narratives (0.84 [SD 0.98] vs 0.36 [SD 0.70], p<0.001).Conclusions and RelevanceIn this cross-sectional study of 100 inpatient Hospital Medicine encounters, LLM-generated discharge summary narratives were of similar quality, and were preferred equally, to those generated by physicians. LLM-generated summaries were more likely to contain errors but had low overall harmfulness scores. Our findings suggest that LLMs could be used to draft discharge summary narratives of comparable quality and safety to those written by physicians.Key PointsQuestionCan large language models (LLMs) draft hospital discharge summary narratives of comparable quality and safety to those written by physicians?FindingsIn this cross-sectional study of 100 discharge summaries, LLM- and physician- generated narratives were rated comparably by blinded reviewers on overall quality and preference. LLM-generated narratives were more concise and coherent than their physician-generated counterparts, but less comprehensive. While LLM-generated narratives were more likely to contain errors, their overall potential for harm was low.MeaningThese findings suggest the potential for LLMs to aid clinicians by drafting discharge summary narratives.