Hospital Discharge Summaries

Lisa Heathcote, Head and Neck Oncology Nurse Practitioner

Purpose of discharge summaries

The majority of our patients undergo complex treatment which continues well beyond their initial admission to hospital. By providing discharge summaries to both patients and their nominated doctors we hope to improve patient outcomes and reduce patient and carer anxiety. Response to this initiative, however, has been varied. GPs love the discharge summaries but not every patient is happy to receive a copy.

Discharge summaries support the transfer of a patient from hospital back to their nominated healthcare provider. A discharge summary is defined as “A collection of information about events during care by a provider or organisation”. There are two audiences for discharge summaries;

  1. General practitioners and other healthcare professionals in primary healthcare settings
  2. Patients and carers

Our discharge summary was designed around the typical questions I am asked by General Practitioners when a patient returns to their care. A discharge summary is prepared each time a patient is admitted to hospital.

What information is included in our discharge summaries?
Heading                 Response
Reason for admission Sometimes the reason for admission is medical rather than surgical. For example, we may need to rationalise a patient’s medications.
Treatment in hospital Chronological list of treatments, consultations and referrals
Current issues This is a straightforward way of highlighting to GPs the patient’s current problems
Speech pathology recommendations Information relating to care including details of treating speech pathologist
Dietician recommendations Information relating to dietary regimen and relevant clinicians
Psychosocial This is an important part of the communication between treating clinicians and GPs as often a local referral is relevant here.
Medications Includes medications not directly related to reason for admission but relevant to inclusion in medication regimen.
Discharge medications List of medications and dosage.
Follow up appointment/treatment List of next appointments arranged while the patient was in hospital.
GP Follow Up Clear communication about which components of patient care are being returned to the GP. For regional and rural patients it is important to specify what parts of their treatment can be managed closer to home versus the parts of their treatment which need to happen on the St Vincent’s campus.
Additional comments This section may include a list of doctors who were involved in the patient’s care during their most recent admission.

Who do the discharge summaries go to?

I supply a copy of the discharge summary to both the patient and their nominated General Practitioner. GPs usually receive an electronic version, and patients receive a hard copy. Ideally I give the discharge summary to patients at their first post-operative appointment. This allows me to explain the document face to face and answer any questions.

Challenges

The biggest difficulty in compiling a patient’s discharge summary is coordinating information from multiple sources, including the hospital’s digital medical records system, bedside charts, and our practice database. And if I am not present when a patient is discharged it is hard to know which drugs they go home on.

Feedback

GPs love the discharge summaries. For instance, one GP told me how helpful it was to be able to refer to the summary when a patient asked for another course of pain relief medication they had been prescribed in hospital. The GP could refer to the discharge summary and confirm that the patient had been sent home with the medication, and also verify the dosage. Other GPs have said that it is great to see when follow up appointments are scheduled. The discharge summaries have also proven to be helpful to other members of the practice team, especially when patients ask, “who was that doctor who saw me in hospital about my (insert other body part here)?”

Surprises

One thing that has surprised me about introducing the discharge summaries is that there are a number of patients and carers who are unsure as to why they are receiving a copy. If I think about it, when I first introduced the discharge summaries I assumed that patients undergoing complex treatment would want to receive a detailed report confirming what happened when they were in hospital and the next steps in their care. But now I can see that this type of communication is not something patients are used to. It is a reminder for clinicians that if we want patients to take an active role in their care and treatment decisions that we may need to develop a range of communication systems suitable for a range of patient responses.


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