How can communication to GPs at hospital discharge be improved? A systems approach

Boddy, Nicholas; Barclay, Stephen; Bashford, Tom; Clarkson, PJ

doi:10.3399/bjgpo.2021.0148

Cited by 6 publications

(8 citation statements)

References 43 publications

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“…Our findings are consistent with literature reporting on the importance of improving two-way communication which may alleviate the patient safety concerns and trust issues raised around clinical handover to primary care and follow up in the community setting [24]. GP-advice models and joint (phone or telehealth) appointments with GPs were seen by some as solutions to improve communication and reduce unnecessary face-to-face appointment with patients in hospitals.…”

Section: Discussionsupporting

confidence: 90%

Hospital doctors’ and general practitioners’ perspectives of outpatient discharge processes in Australia: an interpretive approach

Kruys,

2023

BMC Health Serv Res

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Background Unnecessary delays in patient discharge from hospital outpatient clinics have direct consequences for timely access of new patients and the length of outpatient waiting times. The aim of this study was to gain better understanding of hospital doctors’ and general practitioners’ perspectives of the barriers and facilitators when discharging from hospital outpatients to general practice. Methods An interpretative approach incorporating semi-structured interviews with 15 participants enabled both hospital doctors and general practitioners to give their perspectives on hospital outpatient discharge processes. Results Participants mentioned various system problems hampering discharge from hospital outpatient clinics to general practice, such as limitations of electronic communication tools, workforce and workload challenges, the absence of agreed discharge principles, and lack of benchmark data. Hospital clinicians may keep patients under their care out of a concern about lack of follow-up and an inability to escalate timely hospital care following discharge. Some hospital clinicians may have a personal preference to provide ongoing care in the outpatient setting. Other factors mentioned were insufficient supervision of junior doctors, a patient preference to remain under hospital care, and the ease of scheduling follow-up appointments. An effective handover process requires protected time, a systematic approach, and a supportive clinical environment including user-friendly electronic communication and clinical handover tools. Several system improvements and models of care were suggested, such as agreed discharge processes, co-designed between hospitals and general practice. Recording and sharing outpatient discharge data may assist to inform and motivate hospital clinicians and support the training of junior doctors. General practitioners participating in the study were prepared to provide continuation of care but require timely clinical management plans that can be applied in the community setting. A hospital re-entry pathway providing rapid access to outpatient hospital resources after discharge could act as a safety net and may be an alternative to the standard 12-month review in hospital outpatient clinics. Conclusion Our study supports the barriers to discharge as mentioned in the literature and adds the perspectives of both hospital clinicians and general practitioners. Potential solutions were suggested including co-designed discharge policies, improved electronic communication tools and a rapid hospital review pathway following discharge.

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Section: Discussionsupporting

confidence: 90%

Hospital doctors’ and general practitioners’ perspectives of outpatient discharge processes in Australia: an interpretive approach

Kruys,

2023

BMC Health Serv Res

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“…Many negative events and effects are possible at the primarysecondary care interface. 4 By revisiting the question of 'what is the problem? ', we outline several key areas where opportunities for system changes could provide safety and efficiency gains.…”

Section: What Is the Problem? What Are The Needs? How Can The Needs B...mentioning

confidence: 99%

A systems approach to the safety and efficiency of prescribing at the primary–secondary care interface

Boddy,

Avery

2023

Future Healthcare Journal

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“… 11 A systems approach to enhancing communication between hospital and GPs can improve information flow, and ensure accurate and timely transmission of discharge summaries. 12 …”

Section: Introductionmentioning

confidence: 99%

“…Abbreviations are often misunderstood with different meanings attributed by authors and recipients 12 . A systems approach to enhancing communication between hospital and GPs can improve information flow and ensure accurate and timely transmission of discharge summaries 13 .…”

Section: Introductionmentioning

confidence: 99%

Transforming healthcare documentation: harnessing the potential of AI to generate discharge summaries

Clough,

Sparkes,

Clough

et al. 2023

BJGP Open

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BackgroundHospital discharge summaries play an essential role in informing GPs of recent admissions to ensure excellent continuity of care and prevent adverse events, however, they are notoriously poorly written, time-consuming and can result in delayed discharge.AimTo evaluate the potential of AI to produce high-quality discharge summaries equivalent to the level of a doctor who has completed the UK Foundation Programme.Design & settingFeasibility study using 25 mock patient vignettes.MethodUsing the 25 mock patient vignettes, 25 ChatGPT and 25 junior doctor written discharge summaries were generated. Quality and suitability was determined through both independent GP evaluators and adherence to a minimum dataset.ResultsOf the 25 AI written discharge summaries 100% were deemed by GPs to be of an acceptable quality compared to that of 92% for the junior doctor summaries. They both showed a mean compliance of 97% with the minimum dataset. In addition, the ability of GPs to determine if the summary was written by ChatGPT was poor, with only a 60% accuracy of detection. Similarly, when run through an AI detection tool all were recognised as being very unlikely to be written by AI.ConclusionAI has proven to produce discharge summaries of equivalent quality as a doctor who has completed the UK Foundation Programme, however, larger studies with real-world patient data with NHS-approved AI tools will need to be conducted.

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How can communication to GPs at hospital discharge be improved? A systems approach

Cited by 6 publications

References 43 publications

Hospital doctors’ and general practitioners’ perspectives of outpatient discharge processes in Australia: an interpretive approach

Hospital doctors’ and general practitioners’ perspectives of outpatient discharge processes in Australia: an interpretive approach

A systems approach to the safety and efficiency of prescribing at the primary–secondary care interface

Transforming healthcare documentation: harnessing the potential of AI to generate discharge summaries

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