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174 Making the letter better: a review of quality of discharge letters for patients with palliative care needs at the Royal Derby Hospital
  1. Cathryn Buechel,
  2. Holly O’Nione and
  3. Jillian Wall
  1. University Hospitals of Derby and Burton


Background Limited local and national evidence demonstrates the quality of information in discharge letters for patients with palliative care needs is poor.1,2 We aimed to evaluate discharge letters for patients at the Royal Derby Hospital seen by the hospital palliative care team (HPCT), and hopefully improve the standard of letters for these patients. We know it is important to get this right first time, as for some of this patient group there is only one chance.

Methods Traffic light criteria were established between authors, with red as essential, amber as important and green as nice to know information. 25 sets of HPCT patient notes and electronic discharge summaries were then retrospectively compared against criteria, and data recorded using Excel. This was manually analysed and included qualitative data collection. Interventions following initial data collection included use of a ‘prompt’ sticker and postgraduate education.

Results Against ‘red’ criteria, medication changes were documented well (84%), however Fast Track status was not recorded accurately for 64% and details of the ReSPECT discussion were lacking for 61% of patients. Although 100% of patients were seen by HPCT, only 68% of letters documented this, and most concerningly, preferred place of care (PPC) and preferred place of death (PPD) were documented in 8% and 4% of letters respectively. Against ‘green’ criteria, functional status was documented in 16% of letters, whilst spiritual needs was documented in 4%. Trial of a ‘prompt’ sticker placed in the notes by HPCT was ultimately unsuccessful due to an increase in volume of workload and staff shortages. Education is in progress in Autumn 2022.

Discussion Initial data collection demonstrates that although HPCT gather a wealth of information relating to this patient group which is fundamental to their best care, ultimately this often does not make it as far as the discharge letter.


  1. Alleyne R, Patel M, Lee C. GREAT discharge letters for end of life care patients. BMJ Supportive & Palliative Care 2020;10:A25. Accessed via on 26/07/2022

  2. Grant A, Tomas J. Assessing the quality of hospital discharge letters for patients known to the palliative care services at a large tertiary care centre in central England: a service evaluation. BMJ Supportive & Palliative Care 2021;11:A42. Accessed via on 26/07/2022

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