Discharge notes: how to save time and reduce errors

Long delays between a patient leaving hospital and their GP receiving detailed discharge notes have been an enduring bugbear for the NHS.

Despite using a different system to generate our discharge correspondence from the two other trusts in the area, we’ve still been able to plug into the same delivery network as them

To tackle this, three Cheshire hospital trusts have signed up to a shared communications solution which builds on existing systems at the hospital and the GP surgery. The system is helping acute services meet the new 24 hour service standards for discharge communications delivery and improving patient care (see box).

The 92 GP practices across Cheshire received discharge notification forms and letters in different guises: as post, email or in other electronic formats.

The initial carbon copy discharge updates were often difficult to read and contained only the most basic patient information. The formal discharge summaries from the consultant often did not arrive until weeks, sometimes months, after the patient had been discharged, too late to be of any real use for patient care. GPs were often obliged to take over the care of vulnerable patients with limited details.

Dealing with the different forms of correspondence also put a huge administrative burden on surgeries, with practices spending several hours every week gathering, scanning, reconciling and filing each piece of patient information.

Fifty out of 54 surgeries across Central and East Cheshire Primary Care Trust now receive all their discharge correspondence from Leighton and Macclesfield hospitals electronically every morning. All 38 practices in NHS Western Cheshire also receive discharge letters from the Countess of Chester Hospital Foundation Trust using the same MedisecNET electronic system. Each surgery will eventually receive all clinical correspondence from all three hospitals in the same way.

As the system can collect from any hospital and deliver to any GP system, hospitals printing and posting correspondence can still plug into the electronic delivery network and speed up delivery times dramatically, without having to invest in a major IT overhaul.

Senior IT project manager at Mid Cheshire Hospitals Foundation Trust Diane Nolder comments: “Despite using a different system to generate our discharge correspondence from the two other trusts in the area, we’ve still been able to plug into the same delivery network as them, producing a commonality of approach for GPs.”

Clear audit trail

The system provides a clear audit trail from letter generation to delivery, so both the PCT and hospital can see exactly how long it takes to deliver discharge updates to GPs.

Countess of Chester IM&T clinical systems manager Patricia Reilly explains: “We can now compare how long it’s taking different specialties to generate and issue clinical correspondence.

“By identifying backlogs and areas where action is needed, we can improve communications and deliver better patient care.”

Surgery staff can transfer the information into their practice systems without scanning or duplicating typing, saving time and avoiding errors.

“Before, surgery staff would waste hours scanning hundreds of documents each week,” says Neil Paul, a GP at Ashfields Primary Care Centre in Sandbach.

“Now, because each piece of correspondence is tagged with key data such as patient name, NHS number and specialty, it’s very quick for our staff to authorise and file letters.”

The electronic discharge notification form developed by Leighton Hospital contains mandatory fields to provide GPs with as much information as possible.

Ms Nolder explains that filling the form in is quick and accurate with dropdown menus and a full drug database.

“Test results can also be added into the notes. We’ve worked closely with GPs to produce a template which gives them all the clinical information they need,” she says.

The PCT can monitor service levels remotely to ensure continuity of service and react quickly to delays.

Debi Lees is ICT project manager/business analyst for Cheshire ICT service, Central and Eastern Cheshire PCT.

She says explains: “If a hospital manually posts 100 letters to a GP and only 87 are received, the practice would not know about the missing 13 letters.

“The system automatically highlights any problems, so I can see at a glance if any letters, for technical reasons, haven’t been delivered.

“Our end game is for every surgery in Cheshire to receive all clinical correspondence, not just discharge forms, in the same way.”