tmp7B69 TMP
tmp7B69 TMP
tmp7B69 TMP
Research Article
BJMP 2014;7(3):a724
Abstract
Aim: The discharge summary is a vital component of patient care. It is a means by which information is conveyed to clinicians and community mental
health team who will be involved in follow-up patient care. This calls for accuracy as well as completeness of information as these are vital components that
can directly impact patient care. Timing of discharge letter/summary reaching the follow-up physician, general practitioner or community mental health
team, from point of discharge can also play a key role in patient management. This audit looks at the content and timing of discharge summaries from The
Mount, Old Age Psychiatry hospital as to whether it adheres to the local Trust guidelines.
Methods: Discharge summaries from electronic database were reviewed. In cycle 1 of the audit, adherence to local Trust guidelines in relation to the
content, accuracy and timing of discharge summaries were studied. In the follow-up audit cycle, changes in clinical practice brought about following
recommendations were studied.
Results: Recommendations and feedback were found to be effective in significantly improving adherence to inclusion of family history (p<0.001), social
history (p<0.001), premorbid history (p=0.036), progress and treatment during hospital stay (p=0.049) in the discharge summary. Significant decrease was
observed in inclusion of follow-up arrangements (p=0.007). Other significant improvements included lesser spelling errors (p<0.001), dictation (p<0.001)
and typing (p<0.001) of discharge letter within 5 working days of discharge of patient.
Conclusions: This study adds to importance of accuracy and timing of discharge summaries to ensure good medical practice and continuity of care. It also
establishes scope for improvement and recommendations that can further improve clinical practice. Furthermore, key decisions on patient care can be made
by follow-up health professionals, at the earliest and with the help of appropriate information.
Introduction
The discharge summary is an integral part of continuing patient
care. Apart from containing vital information regarding current
admission, it also conveys key findings and plans to clinicians
who will be taking over the care of the patient. This would
mean communicating important information about patients to
ensure appropriate and safe follow-up management. Studies
involving discharge summaries have looked into role of
communication from secondary to primary care and have
4,5
The timing of
Criteria/ Standards
of the study.
observed (p<0.001).
leads with list of patients discharged during the study dates. The
BJMP.org
Adherence % 2013
(n=97)
Statistical significance
Patient code
100% (n=103)
97% (n=94)
p=0.721
Date dictated
72% (n=74)
98% (n=95)
p<0.001
Patient Name
100% (n=103)
100% (n=97)
No change
Date of birth
97% (n=100)
100% (n=97)
p=0.090
Name of consultant
98% (n=101)
99% (n=96)
p=0.596
Name of current GP
98% (n=101)
98% (n=95)
No change
Admission address
98% (n=101)
100% (n=97)
p=0.167
Discharge address
98% (n=101)
100% (n=97)
p=0.167
Admission date
97% (n=100)
100% (n=97)
p=0.090
Discharge date
97% (n=100)
99% (n=96)
p=0.342
Legal status
99% (n=102)
98% (n=95)
p=0.525
98% (n=101)
98% (n=95)
No change
100% (n=103)
99% (n=96)
p=0.301
89% (n=92)
95% (n=92)
p=0.150
95% (n=98)
98% (n=95)
p=0.282
Family history
19% (n=20)
86% (n=83)
p<0.001
Social history
56% (n=58)
89% (n=86)
p<0.001
Occupational history
67% (n=69)
68% (n=66)
p=0.873
Premorbid history
37% (n=38)
52% (n=50)
p=0.036
95% (n=98)
93% (n=90)
p=0.482
Physical examination
86% (n=89)
92% (n=89)
p=0.227
Results of investigations
84% (n=87)
78% (n=76)
p=0.265
96% (n=99)
100% (n=97)
p=0.049
Final diagnosis
92% (n=95)
97% (n=94)
p=0.147
Discharge medications
98% (n=101)
97% (n=94)
p=0.602
Follow-up arrangements
86% (n=89)
79% (n=77)
p=0.007
64% (n=66)
56% (n=54)
p=0.225
Number of pages
0% (n=0)
0% (n=0)
No change
90% (n=8)
98% (n=2)
p=0.064
78% (n=21)
99% (n=1)
p<0.001
Table 1: The presence of information mentioned in the Trust guidelines is analysed. The percentage adherence in cycle 1 is compared
with findings from cycle 2. Significant increase in inclusion of family history, social history, follow-up arrangements and date of dictation
is observed. A healthy increase is also observed in inclusion of premorbid history and progression and treatment during admission. A
significant reduction in spelling/typing errors is also seen. The decrease in inclusion of name of key worker, discharge medications, mental
health examination and results of investigation amongst others is also noted. GP, general practitioner.
Timing of Discharge Summaries
BJMP.org
this regard.
(p<0.001).
Adherence %
2013 (n=94)
Statistical
significance
0-7
30% (n=22)
73% (n=69)
p<0.001
22% (n=21)
p=0.762
1622
18% (n=13)
4% (n=4)
p=0.004
23+
29% (n=21)
0% (n=0)
p<0.001
working days).
Days Adherence %
2011(n=75)
Adherence %
2013 (n=94)
Statistical
significance
0-5
73% (n=69)
p<0.001
6-11 7% (n=5)
24% (n=23)
p=0.192
12+ 9% (n=7)
2% (n=2)
p<0.001
84% (n=63)
of letter.
Statistical
significance
0-7
18% (n=18)
52% (n=50)
p<0.001
34% (n=33)
p=0.724
14% (n=13)
p<0.001
discharge of patient.
Discussion:
BJMP.org
REFERENCES
1.
2.
3.
Acknowledgements
Dr Zoe Clough and Dr Alex Nalson for their help in data collection for
Cycle 1 of this study. Dominik Klinikowski, Clinical Audit Facilitator
at Leeds & York Partnership NHS Foundation Trust.
Competing Interests
None declared
Author Details
ABHISHEK SHASTRI, MBBS, PGDIP PSYCHIATRY, MPHIL,
Foundation House Officer 2, The Mount, Leeds & York Partnership
NHS Foundation Trust, Leeds, UK. SANTOSH BANGAR, MBBS,
DPM, MD(Psychiatry), PGDip Clin Psy, MRCPsych (UK), ST 5 in
Old Age Psychiatry, The Mount, Leeds & York Partnership NHS
Foundation Trust, Leeds, UK. SHOSHANAH WALDMAN MBChB,
BA, Core Trainee in Psychiatry, The Mount, Leeds & York Partnership
NHS Foundation Trust, Leeds, UK. ELHAM ESFAHANI, MBBS,
Core Trainee in Psychiatry, The Mount, Leeds & York Partnership
NHS Foundation Trust, Leeds, UK. NICK BRINDLE, BSc (Hons),
MB, ChB, MRCP (UK), MRCPsych (UK), Consultant Old Age
Psychiatrist, The Mount, Leeds & York Partnership NHS Foundation
Trust, Leeds, UK.
CORRESSPONDENCE: Dr Santosh Bangar, ST 5, Old Age
Psychiatry, The Mount, 44 Hyde Terrace, Leeds LS2 9LN, United
Kingdom.
Email: [email protected]
BJMP.org
BJMP.org
BJMP.org