Mind the gap: Improving discharge communication between secondary and primary care

Abstract

Foundation year doctors (FYDs) write most hospital discharge communication, although they have minimal training in this skill. Poor quality discharge summaries increase the risk of adverse events and rehospitalisation. With a multidisciplinary team approach, we developed a list of “golden rules” for good discharge communication. Against these standards, we analysed the quality of electronic inpatient discharge documentation (eIDD) sent over two months from OUH Trust. We found one third of eIDDs were missing details of the discharging doctor. In 68%, changes to medications were not documented clearly and follow-up was not completed in 40%.To improve this suboptimal state, we implemented interactive teaching sessions for FYDs, designed an e-learning module, and suggested software changes to the current electronic discharge proforma. Early re-audit one month after the first teaching sessions did not demonstrate any significant improvement. However, re-auditing after twelve months is planned.Through data collection and discussion with key stakeholders, we have identified standards for discharge communication. We developed interventions to help the trust achieve these standards, aiming to enhance patient safety in the peri-discharge period. While discharge communication is delegated to less-experienced team members, they should receive clear guidance and training.

Intensive care discharge summaries for general practice staff: a focus group study

“…The present findings concur with those of Cresswell et al that junior doctors write most hospital discharge notifications, despite receiving little formal teaching on how to do this 12. It was also found that GPs had little understanding of critical illness.…”

“…In line with the experiences of the present study participants, research indicates that hospital discharge summaries are poorly completed and often delayed 10 , 12 , 13 , 26 – 28. Since October 2015, NHS England has required all transfer of care communications to be electronic 29.…”

“…It was also found that GPs had little understanding of critical illness. Educational input that is commenced during initial training, and which is sustained through continuing professional development,12 , 32 is required to optimise this area of practice for all healthcare professionals.…”

“…Alongside specialist critical care services, GP staff (GPs and practice nurses) have ongoing responsibility for monitoring and managing health following hospital discharge 6 , 11. Communication across the secondary– primary care interface is, however, often inadequate;10 , 12 , 13 patients discharged home following critical illness report that GPs have little understanding of their needs or those of their families 14. Kahn and Angus suggest that this may be because GP staff are unaware of events that occurred in the Intensive Care Unit (ICU) 15…”

Sähköisen moniammatillisen kotiutuslistan kehittäminen sairaalasta kotiutuksen tueksi

“…Kokeellisen tutkimuksen avulla on osoitettu, että kotiutukseen liittyvät asiat toteutetaan yleisimmin muistinvaraisesti [21]. Potilaiden sairaalasta hoitolaitokseen ja hoitolaitoksesta sairaalaan tapahtuvien siirtotilanteiden parantamiseksi on kehitetty siirtotietoja koskevan informaation tarkastuslistoja [13,[22][23][24]. Tällaiset ns.…”