Introduction Discharge summaries are fundamental in transferring care from hospital to community. However, our GP colleagues tell us these vital letters require improvement.1 Since 2014, junior doctors from Royal Derby Hospital have examined the quality of discharge summaries written about patients who are reaching their last weeks of life. These patients are eligible for immediate access to NHS continuing healthcare funding, the Fast Track pathway, to facilitate discharge.2 This audit has led to a sticker which is added to the notes when Fast Track is invoked, as a reminder of the important aspects of discharge summaries for these patients. It has also led us to deliver education to foundation doctors about discharging patients at the end of their lives. Here, we present a re-audit evaluating the impact of these interventions.
Method The content of 181 discharge summaries written about patients receiving Fast Track funding produced at Royal Derby Hospital between 31/05/21 and 03/09/21 were reviewed against set criteria. Findings were compared to previous audits to identify trends and areas for improvement.
Results This re-audit had positive and negative findings. We found an increase in documented instructions to GP (62% from 46%), and in anticipatory medications prescribed on discharge (94% from 80%). However, we also found ongoing poor documentation of preferred place of care/death (36% from 38%) and fewer discharge summaries detailing a clear follow-up plan (47% from 61%). This may account for the increase in readmissions in this patient group (9% from 16%).
Conclusion The quality of discharge summaries written about patients who are approaching the end of their life remains variable. Disruptions to service provision and education due to COVID have led to a lack of guidance provided for writing discharge summaries. We recommend reinstating early teaching for junior doctors on this important topic. Re-audit following this is advised.
Kripalani S, LeFevre F, Phillips C, Williams M, Basaviah P, Baker D. Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians. JAMA [Internet]. 2007 [cited 14 September 2022];297(8):831. Available from: https://jamanetwork.com/journals/jama/article-abstract/205790
Fast-track pathway tool for NHS continuing healthcare guidance [Internet]. GOV.UK. 2022 [cited 14 September 2022]. Available from: https://www.gov.uk/government/publications/nhs-continuing-healthcare-fast-track-pathway-tool/fast-track-pathway-tool-for-nhs-continuing-healthcare-guidance#what-the-fast-track-pathway-tool-is
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