Background Patients approaching the end of life have complex care needs which are often addressed in a variety of healthcare settings. Discharge letters are a critical means of communication between primary and secondary care, and play a fundamental role when patients are transferred out of hospital.
Aim To assess and optimise the written conveyance of significant information to GPs about hospital inpatients who had been reviewed by the palliative care team during their admission.
Methods We included all patients at the Queen Elizabeth Hospital Birmingham, over a one-month period, who had been reviewed by the Supportive and Palliative Care Team (SPCT) at least once and then later discharged from hospital. Their discharge letters were interrogated using a bespoke hospital letter assessment tool.
Results Thirty-seven patients were included. Involvement of the SPCT was reported in 54% of discharge letters. Medication changes were mentioned in 59% of discharge letters. Of the patients who were prescribed anticipatory medications during their inpatient stay (n=11), 73% had these mentioned in the discharge letter. None of the few patients discharged on a syringe driver had this reported in the discharge letter (n=3). Changes in resuscitation status were reported in 33% of relevant discharge letters (n=21). Of the patients referred to community palliative care (n=18), 66% had this referral noted in their discharge letter. Discussions about a patient‘s prognosis were reported in 58% of relevant discharge letters (n=12). The physical and emotional wellbeing of patients were rarely reported; functional status was mentioned in 19% of all letters, and emotional wellbeing in 3%.
Conclusions Relevant information is frequently omitted from the discharge letters of patients known to palliative care at our hospital. This includes information relevant to patient safety, care coordination, and end of life decision making. We have proposed an e-discharge bundle to address this issue.
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