Adherence to UK national guidance for discharge information: an audit in primary care

Abstract

AIMSPoor communication of clinical information between healthcare settings is associated with patient harm. In 2008, the UK National Prescribing Centre (NPC) issued guidance regarding the minimum information to be communicated upon hospital discharge. This study evaluates the extent of adherence to this guidance and identifies predictors of adherence. METHODSThis was an audit of discharge summaries received by medical practices in one UK primary care trust of patients hospitalized for 24 h or longer. Each discharge summary was scored against the applicable NPC criteria which were organized into: 'patient, admission and discharge', 'medicine' and 'therapy change' information. RESULTSOf 3444 discharge summaries audited, 2421 (70.3%) were from two teaching hospitals and 906 (26.3%) from three district hospitals. Unplanned admissions accounted for 2168 (63.0%) of the audit sample and 74.6% (2570) of discharge summaries were electronic. Mean (95% CI) adherence to the total NPC minimum dataset was 71.7% [70.2, 73.2]. Adherence to patient, admission and discharge information was 77.3% (95% CI 77.0, 77.7), 67.2% (95% CI 66.3, 68.2) for medicine information and 48.9% (95% CI 47.5, 50.3) for therapy change information. Allergy status, co-morbidities, medication history and rationale for therapy change were the most frequent omissions. Predictors of adherence included quality of the discharge template, electronic discharge summaries and smaller numbers of prescribed medicines. CONCLUSIONSDespite clear guidance regarding the content of discharge information, omissions are frequent. Adherence to the NPC minimum dataset might be improved by using comprehensive electronic discharge templates and implementation of effective medicines reconciliation at both sides of the health interface.

Hospital discharge information communication and prescribing errors: a narrative literature overview

“…The identified study designs consisted of nine retrospective audits:18 19 21 23–26 28 30 six surveys, 17 20 22 23 29 31 one blinded randomised controlled trial (RCT),29 one interrupted time sequence27 and one employing semistructured interviews 18…”

“…Four studies compared handwritten traditional methods with electronically prepared IDLs 23 24 28 30. The studies were published from 2007 to 2014.…”

“…The studies were published from 2007 to 2014. All involved retrospective audits with one study including a GP survey,23 and consisted of a variety of sample sizes ranging from a modest 30 in each arm23 to a comparison of 966 and 842 in another,28 with the largest being a sample of 3444 30…”

“…Two studies demonstrated an improvement in information accuracy using electronic systems with up to 82% completed accurately with electronic versus 62% with paper,23 30 whereas one study showed no significance difference with an error rate of 12.1% with paper versus 13.3% for electronic although both systems required transcription;28 and another reported more errors with the electronic system (13% vs 6% errors) with a free-format section being particularly problematic for errors 24. Two studies demonstrated improved compliance with information documentation of up to 82% compliance with a minimum data set when using an electronic template 23 30…”

Compliance with the Health Information and Quality Authority of Ireland National Standard for Patient Discharge Summary Information: a retrospective study in secondary care

“…This is particularly significant as problems in reconciling the preadmission medication with the discharge medication list can lead to medication error which in turn may lead to preventable adverse drug events 23–25. Predictors of compliance found in other studies included quality of the discharge template, smaller numbers of prescribed medicines and use of electronic rather than handwritten discharge summaries 20. The sample size in this study was too small to compare TEAMS and Symphony compliance with this criterion.…”