Results relating to GP interviews contextualising elements of successful letters, and patient interviews (which investigate patient-provider communication) have already been published elsewhere. The Discharge Communication Study (of which this research is a part) investigated ways of improving the content and processes surrounding discharge letters. Although targets on timeliness appear to have been achieved, the quality of discharge summaries’ content remains less certain and there is now a need to focus on this as a route to improved patient safety during care transitions. Our previous study, conducted in 2016, in general practices in three different areas of the UK, shows that summaries arrive and are uploaded to General Practitioner (GP) systems in a time efficient manner (median of two days from discharge). Hospitals are now required to produce summaries within 24 h. In the United Kingdom (UK), hospitals have been required to use electronic discharge summaries since 2015, and the benefits of such summaries are well established. letter dense with jargon) and general communication gaps leading to adverse events such as patient readmissions. International evidence suggests that discharge letters are unsatisfactory for a number of reasons including: incomplete and insufficient information, unclear follow up plans, letter inaccuracies, delayed letter delivery, inadequate medication information, lack of patient-centredness (e.g. Two inter-related elements are at play: speed of information transfer and quality of information transferred. Poor discharge communication is an important cause of adverse events in medical defence organisation data and incident reports from primary care. This process inherently involves inter-professional communication which has been previously suggested as an area that requires improvement. Sharing accurate, relevant information about the care received in hospital with primary care in the form of a discharge summary is essential to patient safety. While the study highlighted barriers to producing high quality discharge summaries which may be addressed through training and organisational initiatives, it also indicates a need for ongoing audit to ensure the quality of letters and so reduce patient risk at the point of hospital discharge.ĭischarge from hospital is a high-risk healthcare event risk of harm can originate in the secondary care setting or the primary care setting, This is particularly well evidenced in relation to medications errors following discharge. The failure to uniformly implement national discharge letter guidance into practice is continuing to contribute to unsuccessful communication between hospital and general practice. Hospital clinicians identified several barriers to producing “successful” letters, including: juniors writing letters, time limitations, writing letters retrospectively from patient notes, and template restrictions. Analysis of GP comments highlighted that the overall clarity of discharge letters is important for effective and safe care transitions and that they should be relevant, concise, and comprehensible. Unexplained acronyms and jargon were identified in the majority of the sample (≥70% of letters). There were statistically significant differences between “successful” and “unsuccessful” inpatient letters ( n = 375) in relation to inclusion of the following elements: reason for admission (99.1% vs 86.5%) diagnosis (97.4% vs 74.5%), medication changes (61.5% vs 48.9%) reasons for medication changes (32.1% vs 18.4%) hospital plan/actions (70.5% vs 50.4%) GP plan (69.7% vs 53.2%) information to patient (38.5% vs 24.8%) tests/procedures performed (97.0% vs 74.5%), and test/examination results (96.2% vs 77.3%). Resultsįifty-three GPs participated in selecting discharge letters 46 clinicians responded to the hospital survey. Free text comments were analysed using corpus linguistics, and survey data were analysed using descriptive statistics. “diagnosis”, “GP plan”) based on relevant guidelines and standards. Letters were examined using content analysis we coded 15 features (e.g. surveying the hospital clinicians who wrote the sampled letters for their views. GPs commenting on the reasons for their letter assessment, and 3. General Practitioners (GPs) sampling discharge summaries they assessed to be “successful” or “unsuccessful” exemplars, 2. Mixed methods study in West Midlands, England with three parts: 1. In the United Kingdom, although discharge summary targets on timeliness have been achieved, the quality of discharge summaries’ content remains variable. Sharing information about hospital care with primary care in the form of a discharge summary is essential to patient safety.
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