Improving the quality of discharge summaries: implementing updated Academy of Medical Royal Colleges standards at a district general hospital

May-Miller, H; Hayter, Joanne; Loewenthal, Lola; Hall, Louis; Hilbert, Rebecca; Quinn, Michael T.; Pearson, Nicola; Patel, Alisha; Law, R.

doi:10.1136/bmjquality.u207268.w2918

Cited by 6 publications

(9 citation statements)

References 2 publications

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“…39 Strategies such as the use of optimised electronic discharge summaries and automated clinician prompting may improve discharge summary rates, along with auditing and the use of quality assessment tools. [40][41][42] The strengths of the present study include the temporal and clinical trends revealed from an analysis of almost 745 000 ED presentations made by metropolitan Melbourne's older population over a period of 5 years. A limitation of the study is that the AIHW definition used to identify PAGP-type ED presentations has been criticised for overestimating presentations, particularly in older patients, where using triage category as a proxy for urgency and resource requirement can be misleading.…”

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confidence: 99%

Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: findings from the Reducing Older Patient’s Avoidable Presentations for Emergency Care Treatment (REDIRECT) study

Mazza

Pearce

Joe

et al. 2018

Aust. Health Review

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Objective Older patients are over-represented in emergency departments (ED), with many presenting for conditions that could potentially be managed in general practice. The aims of the present study were to examine the characteristics of ED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations. Methods A retrospective analysis was performed of routinely collected data comprising ED presentations by patients aged ≥70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012. Presentations were classified according to the National Healthcare Agreement definition for PAGP-type presentations. Presentations were characterised according to patient demographic and clinical factors and were compared across PAGP-type and non-PAGP-type groups. Results There were 744519 presentations to the ED by older people, of which 103471 (13.9%) were classified as PAGP-type presentations. The volume of such presentations declined over the study period from 20893 (14.9%) in 2008 to 20346 (12.8%) in 2012. External injuries were the most common diagnoses (13761; 13.3%) associated with PAGP-type presentations. Sixty-one per cent of PAGP-type presentations did not involve either an investigation or a procedure. Patients were referred back to a medical officer (including a general practitioner (GP)) in 58.7% of cases. Conclusion Older people made a significant number of PAGP-type presentations to the ED during the period 2008-12. A low rate of referral back to the primary care setting implies a potential lost opportunity to redirect older patients from ED services back to their GPs for ongoing care. What is known about the topic? Older patients are increasingly attending EDs, with a proportion attending for problems that could potentially be managed in the general practice setting (termed PAGP-type presentations). What does this paper add? This study found that PAGP-type presentations, although declining, remain an important component of ED demand. Patients presented for a wide array of conditions and during periods that may indicate difficulty accessing a GP. What are the implications for practitioners? Strategies to redirect PAGP-type presentations to the GP setting are required at both the primary and acute care levels. These include increasing out-of-hours GP services, better triaging and appointment management in GP clinics and improved communication between ED clinicians and patients' GPs. Although some strategies have been implemented, further examination is required to assess their ongoing effectiveness.

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confidence: 99%

Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: findings from the Reducing Older Patient’s Avoidable Presentations for Emergency Care Treatment (REDIRECT) study

Mazza

Pearce

Joe

et al. 2018

Aust. Health Review

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“…Thus, courses in the medical curriculums that cover (correct) writing of medical DS are likely to raise the overall quality of DS. Feedback on written DS, the use of checklists and other well‐designed digital solutions may improve communication and have been shown to be successful methods in improving DS writing 37‐42 …”

Section: Discussionmentioning

confidence: 99%

Structure, content, unsafe abbreviations, and completeness of discharge summaries: A retrospective analysis in a University Hospital in Austria

Schwarz

Hoffmann

Smolle

et al. 2021

Evaluation Clinical Practice

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Rationale and objective The discharge summary (DS) is one of the most important instruments to transmit information to the treating general physician (GP). The objective of this study was to analyse important components of DS, structural characteristics as well as medical and general abbreviations. Method One hundred randomly selected DS from five different clinics were evaluated by five independent reviewers regarding content, structure, abbreviations and conformity to the Austrian Electronic Health Records (ELGA) using a structured case report form. Abbreviations of all 100 DS were extracted. All items were scored on a 4‐point Likert‐type scale ranging from “strongly agree” to “strongly disagree” (or “not relevant”). Subsequently, the results were discussed among reviewers to achieve a consensus decision. Results The mandatory fields, reason for admission and diagnosis at discharge were present in 80% and 98% of DS. The last medication was fully scored in 48% and the recommended medication in 94% of 100 DS. There were significant overall differences among clinics for nine mandatory items. In total, 750 unexplained abbreviations were found in 100 DS. Conclusions In conclusion, DS are often lacking important items. Particularly important are a detailed medication history and recommendations for further medication that should always be listed in each DS. It is thus necessary to design and implement changes that improve the completeness of DS. An important quality improvement can be achieved by avoiding the use of ambiguous abbreviations.

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“…In recent years, national standards have been introduced in some countries with the aim of improving and standardising the content of discharge summaries [ 28 – 30 ]. Such standards can improve the quality of communication at discharge, but audits have shown variable adherence to recommendations [ 31 , 32 ].…”

Section: Can Improving Continuity Of Care At Hospital Discharge Impromentioning

confidence: 99%

Improving continuity of care of patients with respiratory disease at hospital discharge

Dummer

Stokes

2020

Breathe

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Continuity of care refers to the delivery of coherent, logical and timely care to an individual. It is threatened during the transition of care at hospital discharge, which can contribute to worse patient outcomes. In a traditional acute care model, the roles of hospital and community healthcare providers do not overlap and this can be a barrier to continuity of care at hospital discharge. Furthermore, the transition from inpatient to outpatient care is associated with a transition from acute to chronic disease management and, in a busy hospital, attention to this can be crowded out by the pressures of providing acute care. This model is suboptimal for the large proportion of patients admitted to hospital with acute-on-chronic respiratory disease.In a chronic care model, the healthcare system is designed to give adequate priority to care of chronic disease. Integrated care for the patient with respiratory disease fits the chronic care model and responds to the fragmentation of care in a traditional acute care model: providers integrate their respiratory services to provide continuous, holistic care tailored to individuals. This promotes greater continuity of care for individuals, and can improve patient outcomes both at hospital discharge and more widely.Educational aimsTo understand the concept of continuity of care and its effect at the transition between inpatient and outpatient care.To understand the difference between the acute and chronic models of healthcare.To understand the effect of integration of care on continuity of care for patients with respiratory disease and their health outcomes.

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Improving the quality of discharge summaries: implementing updated Academy of Medical Royal Colleges standards at a district general hospital

Cited by 6 publications

References 2 publications

Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: findings from the Reducing Older Patient’s Avoidable Presentations for Emergency Care Treatment (REDIRECT) study

Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: findings from the Reducing Older Patient’s Avoidable Presentations for Emergency Care Treatment (REDIRECT) study

Structure, content, unsafe abbreviations, and completeness of discharge summaries: A retrospective analysis in a University Hospital in Austria

Improving continuity of care of patients with respiratory disease at hospital discharge

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