Discharge Summary and Clinic Letters

Every patient who is discharged from hospital is required to have a discharge summary, documenting many aspects of their care and condition during a visit or stay at hospital. This is a critical tool for communicating information with patients and GPs, however is not always used as effectively as it could be.

The SHOP75+ (Safer Handover for Older People) project team, led by consultants and junior doctors at Salford Royal Foundation Trust, focused efforts on improving the quality of information included within discharge summaries. Initial effort has focused on establishing a feedback mechanism to review the quality of information, including self-evaluation and input from GPs. The agreed focus areas to improve content that is communicated are:

  • diagnosis and clinical summary
  • changes in functional assessment
  • medications started, stopped and changed
  • follow up actions for GP, patient and other care services

In addition to these focus areas, the main aim of the project was:

  • 75% discharge summaries for patients >75yr will score “great” overall by December 2019*

*This aim was for pilot wards

The team collected and reviewed a sample of discharge summaries to generate a baseline to understand what was being done well and areas for improvement. The results showed that on average, only 10% of summaries completed were to a “good” standard. This highlighted the need for the work to continue and support clinicians.

The project team have tested a number of changes including junior doctor led audits, poster feedback, GP feedback, teaching interventions and development of guidance notes. In addition to this, a number of changes have been developed to improve the IT system supporting discharge, for example, the inclusion of automatic DNAR update fields. These tests have tripled the number of discharge summaries being rated “good” and “great” across the core components.

The work will continue to ensure that there is patient involvement in discharge planning and follow up actions, communication with care homes for resident discharges, changes made to EPR/automatic systems and mainstreaming of the project to reach critical mass for staff. A number of tests of change and ideas for improvement are now underway and providing valuable learning as part of the SHOP75+ project, such as empowering discharge champions on target wards, developing in-person training and providing access to direct feedback from GPs.