Here's my guide to the discharge summary.
Your perfect discharge summary should succinctly summarize the key events of the patient's hospital course in narrative form so that someone can look at it and in under a minute have an idea of the most important things that happened during the hospital stay. Did they have a procedure? That should be there. Did they go to the ICU and get intubated? That should go there. And don't forget the basic things: Like why were they initially admitted? What was their ED course? What basic interventions were done? Here's an example of a hospital course for a hypothetical patient with COPD:
Marianne is a 62 year old female with PMH COPD and non-insulin dependent diabetes who was admitted on 6/2 for COPD exacerbation. She initially presented to the emergency department due to worsening shortness of breath, and there her vitals were notable for fever and tachycardia she was noted to have marked hypercapneic respiratory failure with resultant acute encephalopathy, required endotracheal intubation for airway stabilization, and was admitted to the ICU. She was treated with intravenous antibiotics and was extubated without complication the following day and transferred to the regular medical floor. Ultimately, she was found in addition to have RUL lobar pneumonia and was discharged on a 7-day course of levofloxacin and total 5 days of prednisone. She was discharged to a skilled nursing facility with a new 2 L NC oxygen requirement with follow up with pulmonology scheduled for 6/9.
Broad base. Notice I didn't mention every single medication the patient received, and I barely mentioned any actual objective data. The purpose of the summary is to synthesize the information so the PCP and specialists the patient sees in clinic after the hospitalization (and, I suppose, the hospitalist who might have to readmit the patient when treatment fails or the patient worsens) can quickly figure out what happened and what else they need to evaluate to provide great care for the patient.
There are myriad ways to write the discharge summary, and I'm certain someone could shorten mine (but it's a fake patient, so who cares?). But the point is that you just need to tell the reader what happened in broad strokes.
As for fluids? 95/100 times use 0.9% normal saline. Personally, I try to avoid maintenance fluids in most situations. Rhabdomyolysis and pancreatitis require more fluid than maintenance (200-250/hr, usually). If you're doing maintenance, generally it's ideal not to go above 100 mL/hr, and if the patient is small, has heart failure or ESRD, or has sickle cell disease, go lower and think carefully about whether the patient needs fluids at all, especially if they're able to take PO fluids. Commonly, I use LR for acute pancreatitis, and D5 1/2 NS for sickle cell disease, but those may also be somewhat institution specific. In addition, adults generally don't need dextrose, so if you see someone with D5 in their fluid, think about why they might need it and if you can go to a different solution without it.
