“The vast majority of NHS hospitals are expected to miss the government’s target for delivering discharge summaries to GP practices within 24 hours from next April.” eHealth Insider
Blackpool, Fylde & Wyre Hospitals NHS Foundation Trust to achieve 24 hour Discharge Summary target - Click here to read the Press Release
Background:
GPs commonly fail to receive discharge summaries from hospitals in a timely manner. It is also common for the summaries that they do recieve to be poorly written, illegible if hand written, and lacking key information essential to the effective and safe treatment of their patients.
A key consequence is that the hospital may have altered or stopped a particular medication, but the GP is not informed of this so prescribes unnecessary, duplicate or contra-indicated drugs to a patient, with consequent costs and risks to patient safety.
From April 2010, it was made standard procedure for a Discharge Summary to be made available to the GP within 24 hours of the patient being discharged from hospital. There is a national, standardised minimum data set that applies to this summary, which includes:
- Reason for admission/presenting complaints
- Additional diagnosis post admission
- Procedures & Treatments under taken during the episode
- Relevant investigations and results and any still outstanding
- Diagnosis at discharge
- Medications altered, stopped & prescribed with rationale
- Follow up arrangements
- Discharge details, including: Date, consultant & specialty, ward, destination
- NHS Number
Solution description:
Cloud2 have developed a rich solution to address this need, applicable to all Acute Trusts and other organisations required to provide a Discharge Summary.
Discharge Summary articles and news |
| 97% of discharge letters ‘sent back late’, audit finds 01 March 2010 GPs have called for hospital trusts to be financially punished after uncovering evidence that more than 97% of outpatient discharge letters are not being sent back to primary care within the required 48-hour time period. |
| The Discharge Summary Target Almost 50% of GPs are not receiving discharge summaries from acute trusts in time for them to be useful, according to the Care Quality Commission’s report on the state of care in England.In its first annual report, the care regulator found that only 53% of GPs reported receiving discharge summaries in a timely fashion, while 81% said that the details they contain about patients’ medication were incomplete or inaccurate “all” or “most” of the time. |
| Poor hospital discharge information highlighted 15 Feb 08 Faulty discharge information is a key factor in two thirds of cases where frail elderly patients are readmitted to hospital. |
| An audit of hospital discharge and outpatient information from a primary care perspective Information required for appropriate prescribing was missing from 11% of discharge advice notes and 15.2% of discharge letters.Discharge advice note and discharge letter were both available when needed in 8.1% of cases. Comparison between discharge advice notes and discharge letters showed discrepancies in one-third of cases.Important information was missing from 25% of outpatient letters.Transcription errors were common at all stages including transfer of secondary care information to primary care notes. To prevent potentially harmful drug errors further effort is needed to improve systems for information transfer between secondary and primary care. Transcription errors that arise within primary care have been previously unreported. The introduction of electronic prescribing and communication offer a technical solution to significant problems. |
Built as an eForm using Microsoft InfoPath and SharePoint, the eDischarge Form runs entirely in a browser and provides a rapid, easy to use smart form for producing accurate and comprehensive discharge summaries.
Considerable effort has been invested in the user interface to create the smart form, including automatically validated fields, pick lists and date selectors and a natural flow through the form.
Many of the fields are automatically populated directly from the trust’s PAS, saving valuable clinical time and ensuring consistency and completeness.
The application supports the 3 stages
- Clinical Information stage – doctor or other clinician
- Pharmacy Verification stage – pharmacist
- Finalise discharge stage – nurse or ward clerk
Each of these stages is confirmed as being complete prior to the form entering the following stage.
Doctors are able to open an existing summary or create a new one from an intranet portal. PAS integration allows much of the form to be auto-completed based on simple entry of the patient number. Users can rapidly enter clinical information, based on the core Minimum Data Set (see above). Medications are selected using an intelligent search against a drug master file, maintained by pharmacy in SharePoint.
The form allows the pharmacists to amend and comment on any changes they make to the prescription details. These are date/time stamped. A history and audit log is maintained for each summary, with the data and form stored in a SharePoint library for future access.
Once medication is dispensed the form is completed on the ward as the patient is discharged and 2 copies are printed, one for the patient and the second for their patient record. A copy is emailed to the GP using NHS Mail or other secure system. The data could be integrated into the practice systems if required.
Benefits
- Rapid deployment; ~4 weeks to go live
- Meet 24 hour target
- Ensures complete, accurate, legible summary creation
- Anytime, anyplace shared access to summaries
- No software installs on PCs
- Improved information available to GPs,
- Reduces prescription errors and issues
- Ensures treatment and condition information is extended across care boundaries
