CQC raises discharge concerns

Tags: CQC Credit crunch Discharge letters Government GPs Information Governance

16 Feb 2010

The discharge summary target

Almost 50% of GPs are not receiving discharge summaries from acute trusts in time for them to be useful, according to the Care Quality Commission’s report on the state of care in England.

In its first annual report, the care regulator found that only 53% of GPs reported receiving discharge summaries in a timely fashion, while 81% said that the details they contain about patients’ medication were incomplete or inaccurate “all” or “most” of the time.

The government has set a target for all trusts to be sending discharge summaries to GPs within 24 hours of discharge by April this year. However, the target is predicted to be missed by a substantial majority of trusts.

The CQC said “a considerable minority of GPs” were also failing to provide enough information to hospitals on referral. It found that some practices (14%) did not provide information on patients with multiple conditions, allergies (11%) or previous drug reactions (23%).

The CQC said that 11 out of 12 primary care trusts that it visited, with varying characteristics, also had little or no reliable information on whether GPs were sending hospitals the correct information at the right time.

The care regulator said that it also found information governance standards “patchy” and that some trusts have inadequate standards for collecting and analysing data and rely on information “that is of poor quality and not well timed”.

The CQC said its visits found that health and social care staff supported the sharing of information but there were technical and cultural barriers that were preventing it happening.

The CQC’s report said the next big challenge for health and social care was to accelerate efforts to make services more joined up and focused on people’s needs. It also called for investment in services that maintain people’s independence and keep people out of hospital.

The CQC estimated that £2 billion could be saved from hospital budgets if each area was able to reduce the number of admissions and length of stay to match the best performing area in England.

Dame Jo Williams, the CQC’s interim chair, said overall there had been steady improvement in care but that trends such as increasing demand and rising expectations would be exacerbated by pressure on finances.

She added: “That means we cannot go on as we are. To cope, we need some radical changes in the way that we organise and deliver services.

“This means shifting the culture away from a one-size-fits-all approach to care that puts the needs of individuals and carers at the centre of everything. A key part of this will involve helping people maintain their independence and health.”

The CQC said that from April it would introduce new standards which it said would help to form the foundations for the shift towards joined-up, person-centred care.

Link: CQC: State of Health Care and Adult Social Care in England

Fiona Barr

Discharge summary target 'to be missed' (24 Nov 2009) (14)

Reader's Comments

Not important

17 Feb 10 10:02

It is impossible not conclude that discharge information continues to be seen, by many, as "not important". Its a cultural and attitudinal thing, which needs urgently to change if very high readmission rates are to be brought down.

Compliance and "Patient Care"

17 Feb 10 16:02

I have delivered a number of eDischarge projects and a consistant pattern of resistance comes from the clinicians themselves (all of my projects have been sucessfully delivered with good clinician engagement).

Some clinicians welcome any effort to improve the patient experience and these are true clinians. Then there are those (thankfully lesser in number and a vocal minority) who seem to think that the trust works for them and that they "will do what they see fit" - regardless of the impact it might have.

Sorry but these "clinicians" need to get a dressing down and if they don'y comply with improvements to patient care (which eDischarges contribute to) - then shown the door.

I've no doubts that my above statement will cause an outcry - but sorry we are all grown ups here and it's long time overdue that some people stopped behaving live spoilled brats and remembered that they are the employee of the hospital trust - not the employer.

XDS-MS

17 Feb 10 19:02

http://wiki.ihe.net/index.php?title=PCC_TF-1/XDS-MS !

Re:Compliance and "Patient Care"

maryhawking@tigers.demon.co.uk

18 Feb 10 09:02

The discharge summaries are produced by junior doctors - often, it seems, the most junior of them - and to be of use need to be ready (after the medication has been checked by the pharmacist) at the time the patient is discharged.

Small wonder that, in the absence of training, support and time, the quality can be so poor as to constitute a significant risk to patients!

Managers tend to regard just getting something to the GP as being the target: Consultants may appreciate that getting this information to the appropriate GP is part of good patient care, and even recognise that there is existence outside the individual hospital: juniors - in the training grades - have to be taught the importance of discharge summaries and the information required by the GP - or, indeed, at any handover of care..

*Which* clinicians - or managers - are you blaming for either quality or speed of delivery?

No info in - no info out ?

19 Feb 10 12:02

It makes me wonder if there is some link between:

1. the 81% of GPs who said: "that the details they contain about patients’ medication were incomplete or inaccurate “all” or “most” of the time."

and

2. the“considerable minority of GPs (who) were also failing to provide enough information to hospitals on referral"

I wonder if by chance they are related ?