Content area
Full Text
Writing discharge summaries is traditionally the task of junior doctors. They may have had formal or informal training about how to do this, but the quality and amount of training vary. Discharge summaries are too often seen as a lower priority for pressurised junior staff, who might not have had sufficient feedback and supervision in how to produce high quality summaries.
Problems with discharge summaries
The discharge summary should facilitate the safe transition of care from the hospital setting back into the community, delivering information that is both relevant and accurate to aid continuing care. However, errors with discharge summaries are common. In 2002 the Royal College of Physicians audited 149 case notes in five hospitals in England and Wales. Of 87 printed discharge summaries present in the notes, 17% contained no diagnosis, 19% had no procedure, 21% had no follow-up arrangements, and 75% provided the general practitioner (GP) with no information on what the patient had been told. 1 Similar problems with accuracy and prescribing errors have been found in other studies. 2 3 4
GPs are often unhappy with the legibility, timeliness, and accuracy of discharge summaries. In 2009, the Care Quality Commission reported that only 53% of GP practices said they received discharge summaries in time to be useful either "all" or "most" of the time. 5 Only 27% of GP practices reported that discharge summaries were "hardly ever" or "never" inaccurate or incomplete, and 81% of practices reported that details of prescribed medicines were incomplete or inaccurate on discharge summaries "all" or "most" of the time. In one case reported by the NHS Alliance, a patient received a discharge summary 11 years late, although delays of three months to a year are more common. 6
Barriers to quality
A discharge summary is a handover document that explains to any other healthcare professional why the patient was admitted, what has happened to them in hospital, and all the information that they need to pick up the care of that patient quickly and effectively. Producing good discharge summaries is a skill that is often examined at clinical examination stations at medical school. However, in practice there are several reasons why discharge summaries may be unsatisfactory.
Discharge summaries are often produced on the day...