What constitutes a high quality discharge summary? A comparison between the views of secondary and primary care doctors

Abstract

ObjectiveThis study aimed to identify any differences in opinion between UK hospital junior doctors and community General Practitioners (GPs) with respect to the ideal content and characteristics of discharge summaries, and to explore junior doctors’ training for and awareness of post-discharge requirements of GPs.MethodsA piloted anonymous survey was posted to 74 junior doctors at a UK general hospital and 153 local GPs. Doctors were asked to rank discharge summary key content and characteristics in order of importance. GP discharge summary preferences and junior doctor training were also investigated. Non-respondents, identified by non-receipt of a separate participation card, were followed up once.ResultsThirty-six (49%) junior doctors and 42 (28%) GPs returned completed questionnaires. Accuracy was a priority with 24 (72%) GPs and 28 (88%) junior doctors ranking it most important. Details of medication changes were considered most important by 13 (39%) GPs and 4 (12%) junior doctors. Inadequate training in discharge summary writing was reported by 13 (36%) junior doctors.ConclusionsAlthough based on small sample sizes from one location, the level and range of differences in perceived importance of reporting medication changes suggests that many discharge summaries may not currently fulfil GP requirements for managing continuity of care. Results indicate that over a third of junior doctors felt inadequately prepared for writing discharge summaries. There may therefore be both a need and professional support for further training in discharge summary writing, requiring confirmatory research.

Information Transfer and the Hospital Discharge Summary: National Primary Care Provider Perspectives of Challenges and Opportunities

“…Technological solutions such as shared electronic medical records may remedy some of the challenges of HDS availability, but issues of timely preparation and inclusion of relevant content remain. 4,9,16 -18 Previous studies have shown that many physician trainees feel unprepared to write discharge summaries 13 , and that academic medical centers may trail other practice settings in the timely provision of complete summaries. 1,16 The relatively small number of responses within the academic practice subgroup (n ϭ 40) limits our ability to draw strong conclusions; however, the finding that PCPs in academic settings tend to be slightly less likely to have the HDS available at posthospital followup (when adjusted for direct access to inpatient data) offers some validation that this issue lingers.…”

“…9,10 Some study of the interface between hospitalist and PCP has already taken place, confirming the importance of the HDS in this care transition. [11][12][13] To further quantify specific deficits in HDS content and delivery we designed a survey of primary care physicians in the United States. Our aim was to further explore their perceptions of the ideal HDS and deficits in the current state.…”

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

“…Hospitals need to notify PCPs of patients discharged and send the summary for return visits. As the information on many discharge summaries is often inadequate for PCPs to manage continuity of care, 16,78 however, the quality of these summaries needs to be improved, in particular the documentation of drug indications and follow-up. 16 Several limitations of this review should be mentioned.…”

Embedding the clinician-researcher pharmacist in healthcare

“…284 The HDS contains a section documenting changes to medications and provides a list of discharge and continuing medicines. The hospital provides the HDS to the patient's general medical practitioner (GP), aged-care facilities, remote area clinics, or the patient, once the HDS has been completed.…”

“…285 Both junior doctors and medical students have reported receiving inadequate training on how to write discharge summaries, and recognise that a higher priority is often given to more immediately-pressing clinical tasks. 284 Communication failures at the transition between hospital and community can contribute to adverse events and poor patient outcomes. 207,309 A study in 2006 was the first to † † Separations are patient discharges, recorded each time a patient leaves the hospital following treatment.…”