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Getting hospital work by the back door


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Just when you thought things in general, and discharge letters in particular, couldn’t get any worse, they have. That’s if two discharge summaries I received this morning are anything to go by. And they are, because nowadays I seem to suffer discharge dysfunction every time I open my inbox.

So, example one: a 70-year-old lady I admitted last week with breathlessness. Turns out she had an iron deficiency anaemia with an Hb of 8.8. She’s transfused two units and sent home. GI investigations. Nope? Follow up? Nada.

And example two: a 74 year old man I sent in with urosepsis. While on the ward he was diagnosed with AF. Discharged on a beta blocker, no mention at all of anticoagulation, despite a CHA2DS2VASc score of four (my calculation, obviously).

The likeliest explanation is that the medical teams simply omitted the relevant information on the discharge letters. But if I assume this, I will be wrong, and the patient will die of colon cancer or a stroke, respectively.

Hospital discharge summaries have assumed Andrex levels of usefulness

If, on the other hand, I decide that this is an omission of care rather than communication, and make the necessary follow-up arrangements myself, I will also be wrong, and the resulting duplication of appointments will so addle the hospital admin department that all follow up arrangements will end up cancelled and the patient will die of colon cancer or a stroke, respectively.

There are probably many good reasons why hospital discharge summaries have assumed Andrex levels of usefulness: workload, the constraints of computer and protocols, a lack of admin staff, the delegation of clinical tasks to non-clinical staff etc.

Or it could simply be that secondary care has decided to respond to primary care’s BMA-fuelled bouncebacks of dumped work by just pretending that such work no longer exists.

Whatever. The end game is that I have yet another role: a safety net for hospital error and omission. Ironic, really. The Government has ensured that every hospital has a front door doctor screening and redirecting what’s going in. Maybe they’d be better off monitoring what’s coming out.

Dr Tony Copperfield is a GP in Essex 

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Readers' comments (13)

  • Speechless. Nail on head - yet again.
    I remember when hospitals would have seen it as not only their job to explain the anaemia but professionally embarrassing to say "the GP will sort that out".

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  • The trouble is that even the frail elderly are getting kicked out of hospital so damn quickly, they don't even have a chance to make the bed warm.

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  • Ex-GP

    Your role is obviously completely unsafe. Why are you continuing to do the job? I’m sure you are aware you will be held personally responsible for any of the possible errors you have highlighted. You could duplicate this argument over a wide swath of the profession, and yet folk carry on like it’s ok. It isn’t...I’m left thinking we are all fools.

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  • There has been a growth of protocols for non-clinicians to follow allowing them to sign off and action letters. This is a good example of the dangers in allowing this.

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  • Archer

    That's why the Gov (Jeremy) arranged for
    Named Responsible Doctors
    (Unlimited liability)

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  • So we had a patient go to A+E last Wednesday, seen by eye casualty who did note in their letter he had signs and symptoms of malignant hypertension and advised him to see his GP,he came in today .. ..?!!?

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  • This systemic dumping of risk is the most intolerable aspect of GP work.

    If the NHS was really interested in safety it would realise that patients are discharged quickly and in a chaotic manner due to rapid patient turnover and understaffing. It would conclude that there should be automatic follow up of all hospital patients, as a minimum in a funded virtual clinic where a senior doctor reviews the notes, hospital investigations, need for any follow up and ensures the patient and GP are aware of the plan.

    Obviously this won't happen, as the NHS is perfectly designed to produce the cheapest, but not most efficient, tolerable healthcare system to voters. The consequent risk generated by this system is mitigated by a full blame, triple lock GMC, civil court, criminal court system to ensure doctors keep working furiously, plugging the gaps in the rotten threadbare fungus infested Swiss Cheese that the NHS has become.

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  • Jones the Tie

    Big and Small ...I love you ! Bang on , completely endorse what you state

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  • 72 years old came to see me with change in bowel habits over the preceding 4 weeks .Hb was 13.1 a year ago.He was admitted with urosepsis 3 months prior to current symptoms.Out of curiosity I checked his bloods from that admission [on ICE] and HB was 10 on admission, was not even communicated via discharge summary .I referred to colorectal , turned out to be rectal cancer.

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  • 'I referred to colorectal , turned out to be rectal cancer.'

    This counts as a 'win' in the manager's stats as the cancer was diagnosed from a primary care referral, not A&E!

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