Poor hospital discharge information highlighted
Faulty discharge information is a key factor in two thirds of cases where frail elderly patients are readmitted to hospital, a new analysis reveals.
The study suggests getting discharge information right would be a simpler, cheaper and more effective way of preventing the elderly from being readmitted than committing GPs to use of expensive intermediate care services.
Analysis of more than 100 patients over the age of 75 readmitted within 28 days of discharge from hospital found 62% had no discharge letter or were returned before the letter was typed. A quarter of the patients were readmitted for preventable medication-related problems.
These included deterioration following changes in cardiovascular medication, failure to recognise poor compliance and insufficient analgesia. The most common problems arose from recently changed NSAIDs, associated with bleeding in 11 cases.
Professor Tony Avery, a researcher on the study and head of primary care at the University of Nottingham, said: ‘This suggests safe medication management at the interface between secondary and primary care requires considerable improvements in communication. It was often impossible to discern from the TTO form how ill a patient had been, or which of several altered drugs needed most urgent follow-up.
‘Even when a discharge letter was available, prescribing information was often limited.'
Dr Brian Crichton, a GP in Solihull, West Midlands, and honorary lecturer in therapeutics and pharmacology lecturer at the University of Warwick, said although the study was from one hospital it was certainly true that GPs were often working in an information vacuum.
‘It can cause a lot of frustration when you're ringing up trying to understand the train of thought of particular treatments,' he said.
‘It also can be dangerous as patients may be trying to give you information but it ends up being like Chinese whispers.'
The researchers concluded discharge documents should be regarded no longer as a record of events but as a referral back to primary care, with adequate information to ensure continuity.
The data was published in Quality and Safety in Health Care.