Adult patient perspectives on receiving hospital discharge letters: a corpus analysis of patient interviews

Weetman, Katharine; Dale, Jeremy; Scott, Emma; Schnurr, Stephanie

doi:10.1186/s12913-020-05250-1

Cited by 8 publications

(8 citation statements)

References 55 publications

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“…They were asked to select these from letters relating to adult (18+ years) patients discharged from an NHS hospital in Warwickshire, Coventry, Rugby, Herefordshire or Worcestershire following an episode of inpatient or outpatient care, excluding discharge letters from mental health services or related to patients who lacked capacity to consent [27] (for further details and full justification of the inclusion and exclusion criteria, see our study protocol [27]). GP letter selection identified potential participants for all subsequent phases relating to the Discharge Communication Study [27], including patients eligible for interview (these results are published separately [29]).…”

Section: Recruitment and Data Collectionmentioning

confidence: 99%

“…The Discharge Communication Study [27] (of which this research is a part) investigated ways of improving the content and processes surrounding discharge letters. Results relating to GP interviews contextualising elements of successful letters [28], and patient interviews (which investigate patient-provider communication) [29] have already been published elsewhere. In this paper we report clinicians' opinions on the quality of discharge letters which are crucial to understanding how to improve inter-professional communication at the time of discharge.…”

Section: Introductionmentioning

confidence: 99%

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What makes a “successful” or “unsuccessful” discharge letter? Hospital clinician and General Practitioner assessments of the quality of discharge letters

Weetman

Spencer

Dale

et al. 2021

BMC Health Serv Res

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Background Sharing information about hospital care with primary care in the form of a discharge summary is essential to patient safety. In the United Kingdom, although discharge summary targets on timeliness have been achieved, the quality of discharge summaries’ content remains variable. Methods Mixed methods study in West Midlands, England with three parts: 1. General Practitioners (GPs) sampling discharge summaries they assessed to be “successful” or “unsuccessful” exemplars, 2. GPs commenting on the reasons for their letter assessment, and 3. surveying the hospital clinicians who wrote the sampled letters for their views. Letters were examined using content analysis; we coded 15 features (e.g. “diagnosis”, “GP plan”) based on relevant guidelines and standards. Free text comments were analysed using corpus linguistics, and survey data were analysed using descriptive statistics. Results Fifty-three GPs participated in selecting discharge letters; 46 clinicians responded to the hospital survey. There were statistically significant differences between “successful” and “unsuccessful” inpatient letters (n = 375) in relation to inclusion of the following elements: reason for admission (99.1% vs 86.5%); diagnosis (97.4% vs 74.5%), medication changes (61.5% vs 48.9%); reasons for medication changes (32.1% vs 18.4%); hospital plan/actions (70.5% vs 50.4%); GP plan (69.7% vs 53.2%); information to patient (38.5% vs 24.8%); tests/procedures performed (97.0% vs 74.5%), and test/examination results (96.2% vs 77.3%). Unexplained acronyms and jargon were identified in the majority of the sample (≥70% of letters). Analysis of GP comments highlighted that the overall clarity of discharge letters is important for effective and safe care transitions and that they should be relevant, concise, and comprehensible. Hospital clinicians identified several barriers to producing “successful” letters, including: juniors writing letters, time limitations, writing letters retrospectively from patient notes, and template restrictions. Conclusions The failure to uniformly implement national discharge letter guidance into practice is continuing to contribute to unsuccessful communication between hospital and general practice. While the study highlighted barriers to producing high quality discharge summaries which may be addressed through training and organisational initiatives, it also indicates a need for ongoing audit to ensure the quality of letters and so reduce patient risk at the point of hospital discharge.

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Section: Recruitment and Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What makes a “successful” or “unsuccessful” discharge letter? Hospital clinician and General Practitioner assessments of the quality of discharge letters

Weetman

Spencer

Dale

et al. 2021

BMC Health Serv Res

Self Cite

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“…However, improved patient experiences and outcomes have been associated with medical information presented in lay terminology being included in discharge documentation. 13 At our trust, a dedicated 'information for the patient' section is included, which summarises the admission, medication changes and follow-up action needed in lay terminology (Figure 1). Optimising this section is a key marker of our assessment of quality.…”

Section: Discussionmentioning

confidence: 99%

“…12 There is also data to suggest that increased accessibility of the discharge summary for patients reduces their anxiety, increases their satisfaction, and improves attendance rates at follow-up appointments. 13 Therefore, optimisation of discharge summaries has the potential to not only address and mitigate AEs, but also enhance patient experience.…”

Section: Introductionmentioning

confidence: 99%

Improving and Sustaining the Quality of Discharge Summaries

Strange

Ali²,

Holland

et al. 2022

Acute Med

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High quality discharge information communication has been linked to a reduction in the incidence of adverse events, decreasing the risk of prescription errors and lost follow up. In this paper we describe how our trust-wide quality improvement project, led by acute physicians, successfully improved discharge documentation. We demonstrate how we identified obstacles to continued success, and the interventions we implemented. We recommend how discharge summary quality can be optimised through training of junior doctors, recruitment of local champions, and use of novel methods to preserve engagement, such as gamification.

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“…Recruitment and data collection took place, as detailed in previous publications [21][22][23][24] between August 2017 and September 2018. In brief, GPs were asked to screen (see table 1 for screening criteria) and select a sample of recently received discharge letters according to what they considered to be 'successful' or 'unsuccessful' letter exemplars; for each letter, GPs were asked to complete the selection proforma (online supplemental file 1) and rate the letters 'successful' or 'unsuccessful'.…”

Section: Recruitment and Data Collectionmentioning

confidence: 99%

Discharge communication study: a realist evaluation of discharge communication experiences of patients, general practitioners and hospital practitioners, alongside a corresponding discharge letter sample

et al. 2021

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ObjectivesTo develop a programme theory for the intervention of patients receiving discharge letters.DesignWe used a realist evaluation approach and captured multiple perspectives of hospital discharge to refine our previously developed programme theory. General practitioner (GP), patient and hospital clinician views of a single discharge event in which they were all involved were collected using semi-structured interviews and surveys. These were then triangulated to match the corresponding discharge letter. Data were qualitatively synthesised and compared in meta-matrices before interrogation with realist logic of analysis to develop the programme theory that maps out how patients receiving discharge letters works in specific contexts.Setting14 GP practices and four hospital trusts in West Midlands, UK.Participants10 complete matched cases (GP, patient and hospital practitioner), and a further 26 cases in which a letter was matched with two out of the three participants.ResultsWe identified seven context mechanism outcome configurations not found through literature searching. These related to the broad concepts of: patient preference for receiving letters, patient comprehension of letters, patient-directed letters, patient harm and clinician views on patients receiving letters. ‘Patient choice’ was important to the success (or not) of the intervention. Other important contexts for positive effects included: letters written in plain English, lay explanations for jargon, verbal information also provided, no new information in letter and patient choice acknowledged. Three key findings were: patient understanding is perhaps greater than clinicians perceive, clinician attitudes are a barrier to patients receiving letters and that, negative outcomes more commonly manifested when patients had not received letters, rather than when they had.ConclusionsWe suggest how patients receiving discharge letters could be improved to enhance patient outcomes. Our programme theory has potential for use in different healthcare contexts and as a framework for policy development relating to patient discharge.

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Adult patient perspectives on receiving hospital discharge letters: a corpus analysis of patient interviews

Cited by 8 publications

References 55 publications

What makes a “successful” or “unsuccessful” discharge letter? Hospital clinician and General Practitioner assessments of the quality of discharge letters

What makes a “successful” or “unsuccessful” discharge letter? Hospital clinician and General Practitioner assessments of the quality of discharge letters

Improving and Sustaining the Quality of Discharge Summaries

Discharge communication study: a realist evaluation of discharge communication experiences of patients, general practitioners and hospital practitioners, alongside a corresponding discharge letter sample

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