Audit of discharge summaries in Elderly

Audit of discharge summaries in Elderly Care : 

Audit of discharge summaries in Elderly Care Lexi Obee Nargis Pirie Samir Dawlatly Supervisor: Dr Dunstan 24 Nov 2008

Outline : 

Outline Rationale for audit Standards available Standards used Audit method Results Proposals

Rationale : 

Rationale VTS trainees (2 of researchers) aware of interface between primary and secondary care – and its shortcomings Discharge from elderly care can involve change in home setting and GP Having a standardised format can improve discharge summaries1 Deficits in communication are common2 Computer generated summaries should be more consistent2

Local Guidelines : 

Local Guidelines On PICS training site stated that Registrars and Consultants should be completing discharge summaries (!) No guidance on completing discharge summaries at induction for juniors Some wards have own guidelines (Dr Maney)

Standards - RCP guidelines Aug 20073 : 

Standards - RCP guidelines Aug 20073 GP Details . Patient Details Admission Details - Method of admission - Source of admission - Hospital site - Responsible trust - Date of admission Discharge Details - Date of discharge - Time of discharge - Discharge method - Discharge destination type of destination living alone Discharging consultant Discharging speciality/ department Clinical Information - Diagnosis at discharge - Operations and procedures . - Reason for admission and Presenting complaints - Advance decisions to refuse treatment and Resuscitation status - Allergies - Risks and warnings Clinical narrative Very brief narrative description of the in-patient episode. Should include complications and nutritional status. Relevant investigations and Results Relevant treatments and changes made to treatments Measures of physical ability and cognitive function Medication changes Discharge medications Medication recommendations Advice, Recommendations and Future Plan (including) Actions required by the GP. To include: Suggested strategies for potential problems e.g. telephone contact for advice Community and specialist services Information Given to Patient and/or Authorised Representative Patient’s Concerns, Expectations and Wishes Results Awaited Person Completing Summary - Doctor’s name - Grade - Specialty Distribution list

All a bit too much? : 

All a bit too much? And RCP guidelines state not all of these will be relevant in each case

Draft standards used for RCP audit : 

Draft standards used for RCP audit ID of clinician responsible for patient’s care A list of current diagnoses* with dates A list of medications and diets Dose for all prescription medications Frequency for all prescription medications Duration for all prescription medications A problem list A list of procedures with dates Changes to medications since admission A list of allergies/adverse drug reactions Intended outcomes of management Functional status at discharge Follow-up arrangements Support services required Specific instructions for GP Information given to patient Information given to relative That the patient has a copy of the summary Name of validating clinician

Methods : 

Methods 10 patient ID numbers from each elderly care ward discharge book Review of PICS summary ? Valid consultant Each category from Draft Standards rated Yes No Not clear Not applicable

Summary : 

Summary PICS format doesn’t correlate to RCP guidelines Variability in standards of discharge summaries Some thins consistently good, others consistently bad Dr Maney’s juniors do very good summaries

Proposals : 

Proposals 3 broad options: Lobby to have PICS discharge summary changed to conform to RCP guidelines but not just medics use PICS Adopt (?& develop) Dr Maney’s guidelines throughout Elderly Care Include in junior doctor training (?info overload) Complete audit cycle by re-auditing 6 months after implementation

Lastly… : 

Lastly… … why not ask GP’s what they think of our discharge summaries?

Thank you : 

Thank you Any comments or questions?

References : 

References Halasyamani et al (2006). Journal of Hospital Medicine 1(6):354-360 Kripilani et al (2007). JAMA297(8):831-841 http://www.rcplondon.ac.uk/clinical-standards/hiu/Pages/Medical-records.aspx