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Discharge summaries ‘illegible and lack information’



Hospital discharge summaries frequently fail to provide GPs with crucial clinical information and are often illegibly scrawled, a study has found, in what has been described as symptomatic of a system ‘pushed to the limit’.

The audit of more than 3,400 discharge summaries found 33% of handwritten and 26% of electronic summaries fell short of NICE’s minimum standards for clinical communication.

Worryingly, more than half neglected to tell the GP about changes to the patients’ medication, while nearly 43% of handwritten summaries were deemed ‘partially illegible’ and 9% ‘mostly illegible’.

GP leaders said many practices continue to struggle with poor discharge summaries, with the study findings symptomatic of a system that is ‘pushed to the limit’.

‘It’s not surprising given the huge workload and workforce pressures that both primary and secondary care are experiencing,’ said Dr Tim Morton, chairman of the Norfolk and Waveney LMC, where the study took place.

‘There needs to be a continued dialogue about what is actually useful in primary care – not just regurgitating a load of meaningless investigations. We need to know quite clearly: what is the plan of action? What’s expected of primary care? What are the medication changes?’

The University of East Anglia-led study appraised 3,444 discharge summaries sent to GPs in the NHS Norfolk Primary Care Trust between January and March 2011.

These were scored against 14 key clinical criteria, developed from 2008 guidance from the National Prescribing Centre, now part of NICE.

Dr Morton said the quality of discharge summaries was improving thanks to increased dialogue within CCGs, but there was still a long way to go.

He said: ‘We find lots of patients come in before clinical letters and discharge notes have even arrived, which wastes a considerable amount of time. That’s a reflection on the lack of experience that secondary care has of what actually happens in primary care.’

The study found the quality of discharge summaries varied widely between different hospitals and even between wards in the same hospital. Orthopaedic, gastroenterology and general surgery wards were typically the worst offenders.

‘Discharge summaries from these wards persistently recorded no rationale for therapy changes and provided incomplete information related to medicine and co-morbidity history,’ the researchers said.

Dr Ivan Camphor, medical secretary at Mersey LMC, said many areas continued to struggle with poor discharge summaries but an audit by his own CCG had helped improve letters.

Dr Camphor said: ‘I am sure it is a problem nationally – you hear anecdotally from various areas about it. We all know discharge letters are traditionally very poorly drafted and very limited in the information they offer you.

‘I was part of a discharge summary audit that was done on the Wirral, which has made a significant improvement to the quality of summaries coming out of hospitals – particularly the activity and coding, and content of it.’

‘Doing an audit helps to clarify where any bottle neck is and also concentrates the minds of the acute trust as to what is required from primary care.’

Br J Clin Pharm 2014; available online 10 July