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15 To improve the quality of e-discharge summaries for patients potentially in their last 12 months of life using the G.R.E.A.T tool
  1. Bavan Seelan,
  2. Andrew Butler,
  3. Syed Burney,
  4. Johra Alam,
  5. Rea Downes,
  6. Shanthini Avorgbedor and
  7. Ebun Abarshi
  1. Whipps Cross Hospital NHS Trust, Waltham Forest Primary Care


Introduction Concise e-discharge summaries undoubtedly support seamless transition to enable clear treatment plans and ensure that patient preferences considered wherever possible. ‘Ambitions-for-Palliative-and-End-of-Life-Care’ national guidelines emphasise the importance of well-coordinated care; a concise summary will enable this ambition to be fulfilled. Now, discharge summaries fall under the purview of the medical team and serve as primary documents for communicating a patient‘s care plan between settings. While sifting through patient records, doctors need to know which information to include, to ensure excellent follow-up.

Setting Margaret Centre (MC) is an 11-bed specialist inpatient palliative care unit. In its 2021/22 annual report, 1 in 3 of all admissions were discharged to the community. The centre’s vision is to provide ‘specialist services without walls’, achievable through healthy partnerships and collaborations at various levels.

Method As part of the Gold standard formwork, we examined e-discharge summaries for all discharges from 1st January to 30th September 2022. We used the G.R.E.A.T tool, adapted from Dudley Group NHS.

G.R.E.A.T is an acronym for G- GSF Code; R- resuscitation status; E- End-of-life care (EOLC) medications; A-Advance Care Planning (ACP)including the Urgent Care Plan (previously Coordinate-My-Care; and T – treatment escalation plan (TEP).

Results Patients aged 60–102years. 20 males. All potentially within their last 12 months. 9 e-discharges were for Medical Outliers. These were excluded. 32 discharges from MC were to: nursing home (44%), home (38%), acute ward (9%), hospice (6%), and interim placement (3%). 4 discharges had no e-discharge summary.

Of 28 patients with summaries: Patient GSF-code was recorded 36% summaries; resuscitation status 43%; present/absent EOLC medications 61%; inpatient ACP discussions 54%; TEP 50%. All five elements of G.R.E.A.T. present in only 25% of e-discharge summaries.

Conclusion A quarter of e-discharge summaries on patients within the last 12 months of life, did not include any information regarding G.R.E.A.T. Junior doctors can be supported in this respect.

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