Introduction People discharged from hospital via the fast-track (FT) pathway are all felt to be approaching the end of life. These patients are likely to need care from a variety of services. The NICE Quality Standard 13: End of life care for adults recommends coordination of services, including adequate information sharing across organisations, to enable holistic, individualised end of life care. Local GPs fedback to the project authors that hospital discharge summaries often lacked details which could improve coordination of their patients‘ care.
Aims To improve the quality of information included in discharge letters of patients discharged with FT funding from a district general hospital in North London.
Method Following consultation with local GPs and the hospital palliative care team, the project authors identified seven key areas that would help clinicians care for people at the end of life, e.g. details of ACP discussions including DNACPR, prescription of anticipatory medications and contact details for their community palliative care team. Quality improvement methodology was used with repeated PDSA cycles targeted towards doctors responsible for writing discharge letters. Interventions included education and use of a prompt sticker in patient notes. Discharge letters were scored based on the number of key information points included in each letter.
Results During the period studied average letter score increased from 2.8 to 5.6 and the proportion of letters scoring more than 5 increased from 22% to 66%.
Conclusion There was a sustained improvement in the quality of information written in discharge letters over the project period demonstrated by an improvement in both outcome measures. This shows that targeted interventions can improve written communication between hospital and community-based clinicians.
Impact Interventions from the project have been integrated into the hospital palliative care team’s day-to-day practice to facilitate good communication and safe handover to community teams for FT discharges.
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