DischargeBench: Pre-Deployment Evaluation of LLM Discharge Educators through Persona-Grounded Patient Simulation

Discharge summaries are crucial clinical documents containing the context of a patient's overall hospital stay, and are routinely reviewed by medical experts for patient readmission, ongoing care, and diagnostic decision-making. When reviewing them, medical experts often must iteratively synthesize information across multiple discharge summaries while verifying the evidence supporting each answer. Although large language models (LLMs) are increasingly explored for clinical question answering, existing benchmarks do not sufficiently reflect this setting: they often evaluate exam-style medical knowledge or focus on single-turn question answering with limited evidence-grounding evaluation. We introduce EHRNote-ChatQA, the first benchmark for evidence-grounded multi-turn clinical question answering over patients' multiple discharge summaries. Built from de-identified MIMIC-IV discharge summaries, EHRNote-ChatQA contains 967 patient-level multi-turn samples spanning one to five notes and 16,072 medical-expert-verified QA pairs (8,036 content questions, each paired with an evidence-grounding question) across eight clinical categories. The benchmark is constructed through an expert-informed pipeline combining discharge-summary structuring schema, expert-curated multi-turn QA templates, and LLM-based generation, followed by review and revision of every single QA sample by 12 medical experts (11 physicians and 1 nurse). Benchmarking 24 proprietary and open-weight LLMs reveals several challenges, including that LLMs struggle more with evidence grounding than content answering, multi-turn errors compound across turns, and single-turn clinical QA performance does not reliably transfer to this setting. These findings establish EHRNote-ChatQA as a rigorous and practical benchmark for evaluating clinical QA systems.

Evaluating large language models (LLMs) as multi-turn conversational partners requires probing capabilities that single-turn benchmarks miss: persona consistency, evolving intent tracking, emotional dynamics, and goal completion. We introduce EYT-Bench, a human-centered benchmark built around a three-party decoupled design: a persona-grounded user simulator, a target model that separates intent perception from response generation, and an independent third-party LLM judge with optional multi-judge ensembling. Personas are sampled from public human-curated corpora, Nemotron-Personas-USA and PersonaMem-v2, rather than synthesized, reducing LLM-induced persona bias. EYT-Bench also introduces two trajectory-level metrics: embedding-based intent drift and final-intent completion rate (FICR), inspired by tau-bench. In a 17-target x 200-dialogue evaluation, EYT-Bench reveals four findings: (i) state-of-the-art closed- and open-source models are statistically close on subjective dimensions (empathy / persona / anthropomorphism vary within <= 0.3), but differ by up to 9x on objective intent tracking; (ii) reasoning ("thinking on") sharply improves objective tracking on long-context personas (+0.47-0.50 latent-intent accuracy on Gemma-4) while leaving subjective scores nearly unchanged; (iii) persona format dominates trajectory spread, with FICR saturating above 0.95 on Nemotron-USA but spreading from 0.53 to 0.88 on PersonaMem-v2; and (iv) the warm-up effect is robust on 16/17 models (one outlier, GPT-5.5, reverses the effect), with stable rankings across alpha in [0.05, 0.15]. A cross-judge ablation using deepseek-v4-pro confirms that target rankings and final-intent satisfaction are preserved across judges.

Incomplete or inconsistent discharge documentation drives care fragmentation and avoidable readmissions. Despite its critical role in patient safety, auditing discharge summaries relies on manual review and does not scale. We propose an automated framework for auditing discharge summaries using large language models (LLMs). Our approach operationalizes the DISCHARGED framework into a checklist of 46 questions. Using 50 summaries from the MIMIC-IV database, with clinician ground-truth labels, we benchmark 11 LLMs. Model-assessed mean documentation completeness ranges from 54.9% to 74.2%, and the best-performing models achieve a Cohen's kappa values around 0.5 against clinician labels, indicating moderate agreement. All models struggle to identify ambiguous documentation (Unclear), highlighting a key gap in current automated auditing. This work provides a clinician-validated benchmark and zero-shot baselines for systematic quality improvement in clinical documentation.