Hospitals should supply GPs with more detailed notes for patients following their discharge from care for COPD exacerbations, a new report has established.
A clinical audit by the Royal College of Physicians and the British Thoracic Society looked at exacerbations that saw patients admitted to hospital during February to April 2014 concluded that information included in discharge notes was ‘highly variable and generally poor’.
It called for hospitals to ensure that notes include patients’ latest spirometry results, clearly dated, and evidence of any smoking cessation suport was given to current smokers among othjer things.
The report provided a check list which said discharge notes should include:
- MRC breathlessness score in the period prior to admission
- latest spirometry (date and value)
- body mass index (BMI)
- evidence of any decision made around escalation of care, and who has been involved in that decision
- evidence that smoking cessation support has been given to current smokers
- evidence that a pulmonary rehabilitation referral has been made, or is considered inappropriate at the present time
- identification of those with type 2 respiratory failure who are at risk of oxygen toxicity (and confirmation that an oxygen alert card has been issued)
- clear evidence that follow‐up has been arranged (hospital team, community team, GP)
The report said: ‘The clinical data showed that recording of MRC score, spirometry, BMI, documentation of ceiling of care, provision of smoking cessation advice and assessment/referral for pulmonary rehabilitation was highly variable and generally poor. We therefore recommend that these metrics are included within discharge information. Integrating discharge care bundles into the discharge summary and the adoption of admission bundles should similarly facilitate this change.’