E-discharge summaries needed, says GPs
29 Mar 2007
GPs have called for better uptake of electronic discharge summaries to overcome the severe delays and quality issues that many experience with paper-based systems.
A survey by the NHS Alliance of 650 practices revealed that 70 per cent of practices experience severely delayed discharge summaries either very regularly or fairly regularly, with delays of six weeks not uncommon.
One GP told the NHS Alliance: “There is often up to a month’s delay between date of typing [in outpatients] and arrival here, which I refuse to believe is all down to the Royal Mail.”
Nearly six out of ten said clinical care had been compromised as a result of delays while four out of ten (39 per cent) said patient safety had been compromised.
They also cited problems with the quality of summaries received. The report says: “Respondent after respondent told the NHS Alliance that it is not just delays in receiving discharge information that put patient care at risk, it is lack of critical detail. In some cases, even the patient’s name was missing.”
GPs frequently received illegible handwritten discharge summaries. Information about medication was often missing or incomplete, sometimes putting patients at risk.
One GP said: “A patient had been started on warfarin [during admission] and because of the late summary warfarin was not monitored. She then had to be admitted with a very high INR.” [INR refers to blood clotting time; high INR risks internal bleeding].
Respondents felt that Choose and Book was likely to exacerbate problems because it would increase the range of hospitals to which patients are admitted.
One GP said: “The hospital phone number and contact number need to be on [the discharge summary] especially as, with Choose and Book, people may end up in hospitals out of district where we don’t necessarily have much contact and therefore don’t have phone numbers for each department to hand.”
Another asked: “Can’t this be computerised? Our staff can produce a summary of any patients’ records for a consultant etc in a few seconds, and print it off. Can’t the discharge information be stored as the admission goes along instead of all being done in a great rush at the end?”
But Michael Dixon, NHS Alliance chair, said IT would not solve all the problems. “We have highlighted here a culture that is contemptuous towards primary care practitioners. Yes, IT will be a quicker and better way in future but first we need to get the culture right.”
The NHS Alliance wants to see financial penalties for failure to provide timely, high quality discharge summaries built into contracts.
Electronic discharge summaries are available in various parts of the country, as evidenced by a recent report and discussion on E-Health Insider about an implementation in Gloucestershire Hospitals NHS Foundation Trust.
Commenting on the NHS Alliance report, Marc Warburton, chief executive of CIMS, which supplied the Gloucestershire system said : "Improving communications between healthcare providers is key to improving patient care. Fundamentally, the use of IT systems should improve communications across the whole patient care pathway. From referral through pre-operative assessment, treatment and to patient discharge, there is a need to speed up and standardise the flow of information between the healthcare providers.”
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