Discharge summary target 'to be missed'

Tags: 24 hour target A Discharge Discharge letters discharge summaries Document management Government GP GPs HIS NHS Alliance Patient safety Royal Devon and Exeter St TPP

24 Nov 2009

The vast majority of NHS hospitals look set to miss the government’s target for delivering discharge summaries to GP practices within 24 hours from next April.

Dr Mike Dixon, chair of the NHS Alliance, predicts that less than 50% of hospitals will hit the target. Other industry observers have suggested that as few as 20% could be delivering discharge summaries within 24 hours by 1 April 2010, despite a contractual obligation to do so.

Most hospitals are already falling short of the existing government requirement to deliver discharge summaries within 48 hours.

Performance reports from flagship hospitals such as Guys and St Thomas’ NHS Foundation Trust in London show that just under 25% of discharge summaries are produced within five days of discharge, against its own target of 95%.

Great Ormond Street Hopsital in London appears to be doing better, but reported meeting the 48 hour target for only 75% of summaries by the end of August this year. Royal Devon and Exeter NHS Foundation Trust sent just under 65% within 48 hours by the end of October.

Hospitals were recently criticised by the Care Quality Commission for lack of timely or accurate information in discharge summaries.

A survey of 280 practices in selected primary care trust areas found more than 80% thought discharge summaries were inaccurate or incomplete most or some of the time - and only 53% said summaries were received in time to be useful.

Dr Dixon said: “As things stand I think it’s very unlikely that many hospitals will meet the target; probably less than 50%. It’s a long running sore between primary and secondary care and I think there is almost an arrogance from secondary care about it.”

The NHS Alliance has been campaigning for several years to see discharge information delivered to GPs. Dr Dixon said the upcoming 24 hour target had at least stimulated a lot of trusts to get in touch with it about what was required.

Suppliers of electronic document solutions have reported a flurry of interest from trusts ahead of the target, as have suppliers of GP and hospital patient management systems.

A spokesperson for IT supplier TPP said it has had a great deal of interest from hospitals about the possibility of sending discharge letters to GPs electronically.

“We have been providing this for a number of hospitals since April this year and are talking to several more at present,” she added.

However, interest in meeting the target has yet to translate into action in many areas.

Dr Dixon added:”When I talk to GP colleagues and ask them whether things have changed, too many of them tell me that they haven’t.”

Dr Dixon said his ideal would be to see a discharge summary including information on treatment, medications and investigations plus an HRG code of the cost of the patient’s stay given to the patient on discharge, with a copy for their GP.

He added: “This is a very important issue and its not just about patient safety but also about organisation and convenience. If a patient comes out on a Friday evening and runs out of their tablets and you don’t know what they are on it causes chaos for everyone.”

The NHS Alliance has run three surveys on discharge information. The latest, published in October 2008, showed that one in four GPs believed patient safety had been put at risk in the previous six months because of inadequate discharge summaries.

Dr Dixon said he thought the Alliance would run another survey early in the New Year to gauge progress ahead of the April target.

Fiona Barr

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Readers Comments

what do GPs want

mr.acute.cio@live.co.uk

24 Nov 09 08:15

In my experience there is little on no consensus amongst GPs as to how they want to receive and use hospital discharge letters anyway. While at the hospital end the technology is only half of the problem, change management and a consistent discharge discipline amongst clinicians is an equal challenge to the actual electronic transfer.

This GP wants

24 Nov 09 15:59

1) Date of admission and discharge

2) Diagnosis(es) / reason for admission

3) Key investigation results (eg ecgs)

4) Key treatments (eg operations)

5) Discharge medication

6) Any follow-up arrangements

7) Anything the GP needs to follow up.

8) All to arrive quickly enough to prevent clinical risk not, "GP please repeat test in 3 days" which arrives 2weeks after discharge.

Yes, we would like bells and whistles when it is possible but basic data, in a timely manner, would be a major step forward.

its not so much what you want but how

mr.acute.cio@live.co.uk

24 Nov 09 18:24

yes, the list from the GP is fine but how to receive and use it is ambigious (varied) to many acute services. Until GPs use the same systems that accept and handle this data direct in to practice IT systems (yes some do but many don't) and apply similar operational procedures, the Darzi goald will remain goals. but the NHS has actually made considerable progress, just not there yet.

Discharge letters

a.stephens62@ntlworld.com

24 Nov 09 22:56

I may be getting senile but when I left Lewisham Hospital in 2002 I seem to temember that we had been sending GP Discharge letters for 2 or 3 years and had demonstrated this to Nigel Crisp, numerous ephemeral Ministers and anyone else who wanted to see them. What has happened during the last 7 years and where has all the cash gone?

Nice list

25 Nov 09 10:08

The list above is spot on. The medical side of our local hospital have excellent policies resulting in most summaries being sent home with the patient with a copy to us. The surgical side sends out the fourth or fifth layer of a carbon pile. Those that aren't illegible have incorrect or insufficient information and the formal letter can take weeks. Don't even start on the Centres of Excellence like Liverpool. Some departments NEVER send any letters. Yes, we have made these into significant events for all and sundry and still nothing happens.

GP Systems need work as well...

25 Nov 09 10:47

To be honest, primary care systems are just as much at fault. Our local acute has been desperate to send discharge summaries electronically via DTS but the GP clinical systems also need to be able to receive them.

TPP have been fantastic and worked with our local acute to make it happen. Our Vision sites have also been able to get them with a minimum of fuss.

EMIS on the other hand have been useless. The functionality within LV is appalling and the reports need to be viewed in yet another bolt on that is slow and clunky. I find it hard to believe that EMIS could have made the process less user friendly if they had tried. Of course, it is better than PCS which once again is missing functionality that LV has. EMIS could not care less and only seem interested in Web these days...

NPfIT

25 Nov 09 11:02

In my view NPfIT has been the primary cause of lack of progress. If targeted money had been injected directly into providers and GP practices to fund individual development, nurturing the growth of the systems in place or buying modest new ones in a step wise development, this would have been sorted years ago. Instead someone important decided that it was more important that if someone broke their leg in Cornwall we could see it in Newcastle or some other such tosh. No doubt loads of people under the pay of NPfIT will respond with outrage but the truth is the strategy was wrong. We concentrated on centralist control instead of innovation at the grass roots.

This (retired) GP wants..

david.churchill@nhs.net

25 Nov 09 17:21

any e-mailed discharge summaries sent to me electronically (in my present role as an IT manager in general practice) to be free from inflating rubbish like NHS and hospital trust logos which slow the transfer to us via NHS mail to a crawl and result in a file that take anything up to 3/4 minute to open once electronically attached in our Crosscare system. Simple word based summaries and discharge and OPD letters are fine - and very easy to manage - but do I really want to spend what may amount to hours in my day waiting for pretty headed paper to open every time a scratch is seen in A & E??

item No 8

25 Nov 09 18:20

I realise it is off topic, but you (a GP practice manager!) raised it. If your practice (all GP practices) revised your working practices, especially out of office hours, we wouldn't get so many "scratches" turning up at A&E and so wouldn't have to tell you about them.

to the last poster

cunpr@globalnet.co.uk

26 Nov 09 08:54

Well done for de-railing a thread. Having worked at reg level in several A/Es, having run a 280 GP OOH co-op for 10 years, having been a GP for 20+ yrs, having been instrumental in securing an NHS Direct site for South London and then being on its initiating board and finaly having sat on acute services reveiw boards considering the fate of several A/E departments I think I can report that the reasons why people turn up in A/E departments is complex and what the local GPs are doing is but one actually very small influence. You can after all correlate A/E attendances with TV schedules and pub opening times.

This thread is about the desire for IT interoperability. That won't stand a chance if people like you continue to promote erroneous dogma. The first step to IT systems intergrating is understanding between the humans sitting behind them.

Regards

Paul C

not only timely but accurate

maryhawking@tigers.demon.co.uk

26 Nov 09 18:07

There doesn't seem to be any reason why electronic discharges cannot be transferred using the same system as EDI: they certainly are here (EMIS LV btw) - but unless you have ICE - or the equivalent - in all areas, in all the practices in every area and supported by all the system suppliers at both hospital and practice ends, I don't see that there will ever be a single way of doing things. All GP practices receive discharge summaries from an often large number of different hospitals - some at a considerable distance and outside both the PCT and SHA areas - and equally, all hospitals will be sending a number of discharge summaries to practices outside their catchment area. I like getting EDLs (Electronic Discharge Letters) via EDI: receiving them by NHSMail would mean importing them into the clinical system's document management, necessitate a practice NHSMail practice address and change of systems within the practice (not insurmountable) and, worst of all, it would need a system at the hospital end to make sure that the EDL reached the correct practice: you can't send an email back to the PCT in the black bag! Pity the quality of information seems to have deteriorated - not that it was that good previously - but what do you expect when junior doctors who may never have seen the patient are expected to write full discharge summaries between the patient being discharged on a ward round and lunchtime?

re the multifunctional GP

26 Nov 09 19:11

I wonder if you have ever tried to see your GP out of office hours, like if you commuted to london.

Also wonder if you have ever tried to please more than one GP at a time.

If so, add superman to your CV.

EDI and EDLs

27 Nov 09 11:28

As an practice IT manager , Emis LV 10yrs, I would favour

1) edi

2) email of a concise simple document

Edi has proved itself to be a incredibly reliable data transfer sytem with good patient matching and the ability to use Drs inboxes if need be. Edi has worked thanks to the expertise of path lab technicians in dealing with data and would be more challenging to other parts of a hospital organisation.

Second choice email of a concise document with the info the list previously suggested. This works quite well with reports we receive from Physiotherapy, but not as streamlined as edi. Would be better for EDLs than the scawl we used to get from the hospital mail bag!

Our local hospital thinks its OK to send an email saying “connect to our hospital patient information system and go and find the discharge letter on this patient”. It may be there , if it isnt look again in a couple of days and it may appear. To me this is dereliction of duty of the hospital to send timely important patient information. Unbelievable but true!

Solutions exist but need human cooperation

30 Nov 09 20:09

We have EMIS LV and PCTI Docman.

Our local hospital is set up to send us hospital letters which can end up directly in our Docman workflow intrays, as long as the secretary completes the tag data required and then sends the letter to the designated Practice email address. This is extra work and often but not always happens, but when it works it works well.

It does need a bit of setting up and we have the advantage of one main local hospital.

However we are aware that other practices do still prefer paper.

And of course there is on the face of it not much in it for the secretary who types the letter.

The point being that it can be brilliant, but takes a will and effort on both parties.