Level of accuracy of diagnoses recorded in discharge summaries: A cohort study in three respiratory wards

Tsopra, Rosy; Wyatt, Jeremy C.; Beirne, Paul; Rodger, Kirsty; Callister, Matthew; Ghosh, Dipansu; Clifton, Ian; Whitaker, Paul; Peckham, Daniel

doi:10.1111/jep.13020

Cited by 24 publications

(18 citation statements)

References 35 publications

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“…Our findings have been consistent with existing literature, particularly in terms of the key role of discharge communication in patient safety 4,8-10 and coordination of healthcare services 45,46 , underlining the need for improvement in terms of quality and consistency 6,13,29,47 . Further to this, a more holistic understanding of a typical NHS discharge communication system has been uncovered and drawn together, contributing clarity to the challenge of how discharge communication might be improved.…”

Section: Comparison With Existing Literaturesupporting

confidence: 90%

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

et al. 2021

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BackgroundPoor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue’s resistance to decades of improvement work.AimTo understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement.Design, SettingA qualitative exploration of the secondary-to-primary care communication system surrounding a UK tertiary hospital.MethodA ‘systems approach’, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n=18) of clinical and administrative staff from both sides of the primary-secondary care interface and a subsequent focus group.ResultsThe largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates.ConclusionFacilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance, such as patient complexity.

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Section: Comparison With Existing Literaturesupporting

confidence: 90%

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

et al. 2021

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“…For example, in all three patients diagnosed with diabetes during their admission, this was in their discharge summaries, along with newly prescribed medications. Ideally, a request for follow-up should be found in the discharge referral of patients diagnosed with diabetes or those found to have blood glucose or HbA1c results suggestive of diabetes, and absence of such records may compromise the ability for treatment and prevention of complications [18,29,30], which may result in a higher risk of re-admission [31].…”

Section: Discussionmentioning

confidence: 99%

Diabetes Detection and Communication among Patients Admitted through the Emergency Department of a Public Hospital

Osuagwu

Webb

Simmons

2020

IJERPH

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Early identification/diagnosis of diabetes and frequent monitoring of hyperglycemia reduces hospitalizations and diabetes-related complications. The present study investigated the proportion of older adults coded with diabetes or newly diagnosed during their admissions and assessed discharge summary content for diabetes-related information. The study used electronic data on 4796 individuals aged ≥60 years admitted through the emergency department (ED) of a public hospital from 2017 to 2018 extracted using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM code). The proportion of admitted patients who were diagnosed with diabetes over a one-year period, proportion with glycated hemoglobin A1c (HbA1c) and random blood glucose (RBG) test performed during their stay, length of stay, discharge summary information and the factors associated with elevated HbA1c (>7%/53 mmol/mol) were investigated. In total, 8.6% of ED presentations to the hospital were coded with diabetes, excluding gestational consisting of 879 patients (449 males, 430 females) aged ≥ 60 years (74.6 ± 8.9 years). In total, 98% had type 2 diabetes (n = 863), 53% were Australian-born (n = 467), and the mean body mass index (BMI, 31 ± 7 kg/m2; n = 499, 56.8%), RBG (9.8 ± 5.2 mmol/L; n = 824, 93.7%) and HbA1c (8.0 ± 2.0%; n = 137, 15.6%) and length of stay (6.7 ± 25.4 days) were similar between gender, age, and nationality (p > 0.05). Three coded patients (0.3%) were newly diagnosed during the admission. In total, 86% had elevated HbA1c, but this was recorded in 20% of discharge summaries. Patients who are on a combination therapy (adjusted odds ratio 23%, 95% confidence intervals: 7%/38%), those on SGLT2 Inhibitors (aOR, 14%: 2%/26%) or had a change in medication (aOR, 40%: 22%/59%) had lower odds of having elevated HbA1c during admission. The low diagnosis rate of diabetes and the lack of clinical assessment of HbA1c in older adults admitted through the ED of a South Western Sydney public hospital suggest that many patients with diabetes either remain undiagnosed even during admission and/or are going to the ED with unknown diabetes that is unidentified with current practices. The clinically important HbA1c results were only infrequently communicated with general practitioners (GPs).

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“…The Read codes seemed to suggest the opposite problem; there are a large number of codes for recording a CF condition, suspected or otherwise but given the wide choice, a simple CF diagnosis code was often chosen. The use of coding systems in a consistent manner and the limitations apparent in some coding systems, is a recognised concern in the use of EHR [10,30] and the reasons for the misclassified cases seemed consistent with this concern.…”

Section: Discussionmentioning

confidence: 93%

Identifying children with Cystic Fibrosis in population-scale routinely collected data in Wales

Griffiths

Schlüter

Akbari

et al. 2020

IJPDS

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Introduction The challenges in identifying a cohort of people with a rare condition can be addressed by routinely collected, population-scale electronic health record (eHR) data, which provide large volumes of data at a national level. This paper describes the challenges of accurately identifying a cohort of children with Cystic Fibrosis (CF) using eHR and their validation against the UK CF Registry. Objectives To establish a proof of principle and provide insight into the merits of linked data in CF research and the benefits of access to multiple data sources. In particular, the UK CF Registry data, and to demonstrate the opportunity it represents as a resource for future CF research. Method Three eHR data sources were used to identify children with CF born in Wales between 1st January 1998 and 31st August 2015 within the Secure Anonymised Information Linkage (SAIL) Databank. The UK CF Registry was later acquired by SAIL and linked to the eHR cohort to validate the cases and explore the reasons for misclassifications. Results We identified 352 children with CF in the three eHR data sources. This was greater than expected based on historical incidence rates in Wales. Subsequent validation using the UK CF Registry found that 257 (73%) of these were true cases. Over 98% of individuals identified as CF cases in all three eHR data sources were confirmed as true cases; but this was only the case for 19.8% of those identified in a single data source. Conclusion Identifying health conditions in eHR data can be challenging, so data quality assurance and validation is important or the merit of the research is undermined. This retrospective review identifies some of the challenges in identifying CF cases and demonstrates the benefits of linking cases across multiple data sources to improve quality.

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Level of accuracy of diagnoses recorded in discharge summaries: A cohort study in three respiratory wards

Abstract: Our study showed that diagnoses were not accurately recorded in discharge summaries, highlighting the need to measure and improve discharge summary quality.

Cited by 24 publications

References 35 publications

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

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

Diabetes Detection and Communication among Patients Admitted through the Emergency Department of a Public Hospital

Identifying children with Cystic Fibrosis in population-scale routinely collected data in Wales

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