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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