All patients admitted to hospital should have a discharge summary completed, including those that have died during their admission. This ensures good continuity of care between secondary and primary care.¹ We looked at the current level and practice of doctors competing discharge summaries for these patients, and the quality of information provided.

We initially looked at patients who died between November and December 2018. 114 patients died. Only 35 (31%) patients had a discharge summary completed. A survey of junior doctors highlighted confusion about what documentation was required, they felt they are often too busy to do discharge summaries and see patients who have died as a lesser priority.

A project was conducted to highlight the importance of these summaries and to improve the quantity and quality of them being done. This included presenting our initial data at Grand Round, the Junior Doctor Forum and piloting a ‘Bereavement Box’ on one of the medical wards. This was used in morning board rounds to highlight summaries that needed to be done, but to also use it as an opportunity to debrief and learn from deaths.

Following these changes, we looked at the deaths in June 2019. 55 patients died. 33 (60%) patients had a discharge summary completed. 100% of patients who died on the ward with the ‘Bereavement Box’ had a discharge summary.

With these interventions, there was a 100% increase in discharge summaries being completed. However, there are still further improvements to be made. We plan to roll the ‘Bereavement boxes’ out to all wards, make an automatically generated notification sent to the GP upon a patient’s death and roll out Medical Examiners within the Trust. We hope that these further interventions will ensure that all patients will have discharge summaries completed and there will be improved continuity of care.

References

1. Murphy SF, Lenihan L, Orefuwa F, Colohan G, Hynes I, Collins CG. Electronic discharge summary and prescription: improving communication between hospital and primary care. Ir J Med Sci 2017 May;186(2):455–459. doi: 10.1007/s11845-016-1397-7. Epub 2016 Jan 25.