GPs say lack of discharge data puts patients at risk

Tags: Contract Discharge summaries Drug Safety

17 Oct 2008

One in four GPs has seen patient safety put at risk in the past six months because hospitals have failed to provide adequate discharge summaries, according to the NHS Alliance.

The Alliance says the results of its third annual survey on patient discharge information were particularly disapppointing since a new NHS Standard Contract was introduced in April.

The contract, which does not apply to some foundation trusts and independent sector treatment centres on old contracts, requires hospitals to provide discharge information within 72 hours of a patient’s discharge.

“Six months on, we had hoped to see clear, even if limited, signs of improvement," says a report from the Alliance, which is holding its annual conference this week.

"There was even the possibility that foundation trusts operating under existing contracts would be motivated to meet what is now obvious good practice. We were disappointed.”

The report says that even though more hospitals are providing electronic discharge summaries and that more are making an effort to ensure information is provided promptly, the same proportion of GPs continues to report that they experience late discharge information “very” or “fairly” often – a total of 72% in 2006, 70% (2007) and 71% (2008).

In 2007, one in five doctors said they had never had a case where patient safety had been compromised by late discharge information. In 2008, that number had almost halved to one in ten.

Dr Mike Dixon, chairman of the NHS Alliance, said hospitals should now not be paid until they have delivered prompt, accurate and complete discharge information.

He added: “This is a shocking indictment of current practice in secondary care. Hospitals seem not to understand nor care that ill patients still need treatment from their family doctor when they go home.”

Earlier this year, GPs called for better upake of electronic discharge summaries after another Alliance survey found that 70 per cent of practices experience severely delayed discharge summaries either very regularly or fairly regularly.

Problems highlighted by the most recent survey included discharge information arriving months or even years late, illeigble handwritten letters, summaries that fail to mention drug allergies or intolerances and letters that fail to give the patient’s name or any contact details at the hospital.

As well as withholding payments until discharge summaries are provided, the Alliance wants to see a new requirement on hospitals to include the full Payment by Results HRG coding and the costs that will be invoiced with the discharge letter.

The Alliance said that would ensure complete clarity and improve activity data at the same time.

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Reader's Comments

simple solutions needed

ben.toth@gmail.com

21 Oct 08 20:10

There are some incredibly simple technical solutions to this problem - for example a secure RSS feed from an EPR to a primary care system that notified a GP of every significant event taking place to a patient in hospital. But this would require a degree of willingness to share data that is lacking on both sides of primary care secondary care divide, the root cause of the problem identified here.

Electronic discharge summaries

22 Oct 08 09:10

There are two distinct issues with discharge summaries. Firstly the prompt transfer of information to the appropriate recipient. This seem to be the key Quality indicator at the moment as it is easy to measure. More important however is the quality aspect as it is particularly dangerous if a discharge summary is transmitted in good time but contains erroneous information or omits essential information. As a pharmacist we see consistently poor summaries being transmitted in our trust but find our staffing resources are insufficient to allow the pharmacy team to view all summaries and correct the errors in time.

A final thought is that there is an element of pots and kettles here as admission information from GPs is also a major area of concern especially lists of mediaction on admission hence the need for the NICE reconciliation guidance.