Background Provision of hospital discharge information to community palliative care services helps to ensure continuity of care following hospital admission. However, the quality of discharge information can vary which can make it harder for patients’ care preferences to be fulfilled. Improving the quality of discharge letters can potentially improve palliative care for patients discharged to community settings.
Aim To improve the quality of discharge letters for palliative care discharged from a hospital palliative care in-patient unit (PCU).
Method Retrospective analysis of discharge letters and electronic records over a 7-month period in 2021 from a PCU in the Northwest of England. We collected the following data: presence of a discharge letter, Gold Standards Framework (GSF) status, resuscitation status, symptom control medications, Advance Care Planning (APC) documentation, preferred place of care and follow-up plan. We used our findings to make recommendations to improve care.
Results Approximately 76% of patients had cancer and 24% had non-cancer diagnosis. Nearly all patients were discharged with appropriate end-of-life medications. In all cases the appropriate community follow-up was described with an emergency contact number given to all patients. Do not attempt cardio-pulmonary resuscitation (DNACPR) decisions were documented in 73% discharge letters despite all patients discharged with a copy of their DNACPR form and evidence of a discussion. Future care conversations took place in most patients, ACP form was completed in only 30%. GSF register status was documented in 57% of discharge letters.
Recommendations Palliative care specific discharge letter pro forma should be created for all patients to report DNACPR, GSF and future care discussions and ensure all relevant information is included. We developed the mnemonic GRASP to support capture of relevant information: G= GSF status, R= resuscitation status, A = anticipated care plan, S = symptom control medications and P = preferred place of care. They should all be documented in all discharge letters.
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