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47 GREAT discharge letters for end of life care patients
  1. Richard Alleyne,
  2. Maya Patel and
  3. Corlyn Lee
  1. Dudley Group NHSFT


Background Hospital discharge letters for End of Life Care patients are often poor. The lack of communication from the hospital to community teams regarding essential issues which is needed for community teams to plan care, can lead to poor care including avoidable re-admission to hospital.

Methods Standards for discharge letters from Russells Hall Hospital in Dudley for End of Life Care patients were designed. The mnemonic GREAT was used to remind those writing discharge letters to update community teams about: GSF Needs code/Resuscitation status/End of life medications/Advance Care Planning/Treatment Escalation Planning. An audit was conducted looking at discharge letters for End of Life Care patients to see whether GREAT was used and whether or not this made any difference to the care of the patient. Re-audit done 12 months later looked at whether or not there was sustained use of GREAT and improved care.

Results GREAT has become the gold standard of information required on discharge letters for End of Life Care patients in Dudley. The results showed that in both years, patients who died at home had higher quality discharge letters (use of GREAT), and patients who had been discharged from hospital, but readmitted and died within 12 weeks, had poorer quality discharge letters.

Conclusions GREAT reminds discharge letter writers to include information that is essential to pass on to community staff caring for End of Life Care patients. Embedding GREAT as the gold standard of content has led to an improvement in the quality of discharge letters.

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