General practitioners’ perspectives on discharge summaries from a health network of three hospitals in South Australia
Nicholas L. Scarfo
A , Sayeh Dehghanian A , Mai Duong B , Richard J. Woodman C , Pravin Shetty C D , Henry Lu E and Cameron J. Phillips A C E *
A SA Pharmacy, Level 3, Southern Adelaide Local Health Network, 1 Flinders Drive, Bedford Park, SA 5042, Australia.
B General Practice Integration Unit, Marion GP Plus, 10 Milham Street, Oaklands Park, SA 5046, Australia.
C College of Medicine and Public Health, Health Sciences, Level 4, Health Sciences Building, Registry Road, Flinders University, Bedford Park, SA 5042, Australia.
D Division of Medicine, Southern Adelaide Local Health Network, Level 6, 1 Flinders Drive, Bedford Park, SA 5042, Australia.
E Clinical and Health Science, University of South Australia, City West campus, North Terrace, Adelaide, SA 5000, Australia.
Australian Health Review 47(4) 433-440 https://doi.org/10.1071/AH23072
Submitted: 11 April 2023 Accepted: 23 May 2023 Published: 26 June 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objectives To explore general practitioners’ perspectives on the discharge summaries they receive about their patients who have been discharged from hospital.
Methods A survey of general practitioners in the catchment of a major metropolitan South Australian health service consisting of three teaching hospitals was undertaken. Surveys were disseminated electronically and via hardcopy mailout to general practitioners. The 36-question survey focused on five constructs of discharge summaries: accessibility, length and clarity, format, transparency, and medicines content.
Results A total of 150 general practitioners responded (response rate, 27.6%). Respondents were vocationally registered (96%), predominately from metropolitan practices (90.2%), and 65.8% were female. Overwhelmingly, 86.7% of general practitioners stated that the optimal time for receipt of discharge summaries was <48 h post-discharge, and 96.6% considered that late arrival of discharge summaries adversely impacts patient care. The ideal length of discharge summaries was reported as <4 pages by 64% of respondents. A large proportion of respondents (84.6%) would like to be notified when their patients are admitted and discharged from hospital, and 82.7% were supportive of patients receiving their own copy of the discharge summary. A total of 76.7% general practitioners reported that they had detected omissions or discrepancies in the discharge summaries. Provision of rationale for medication changes was viewed as important by 86.7%, however, only 29.3% reported that it is always or often communicated.
Conclusions General practitioners supported timely receipt, concise length of discharge summary and format refinement to improve the utility and communication of this important clinical handover from hospital to community care.
Keywords: clinical handover, discharge summary, general practitioner, information transfer, physician, separation summary, survey, transition of care.
References
[1] Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care. JAMA 2007; 297 831–41.| Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care.Crossref | GoogleScholarGoogle Scholar |
[2] Hansen LO, Strater A, Smith L, Lee J, Press R, Ward N, et al. Hospital discharge documentation and risk of rehospitalisation. BMJ Qual Saf 2011; 20 773–8.
| Hospital discharge documentation and risk of rehospitalisation.Crossref | GoogleScholarGoogle Scholar |
[3] McAlister FA, Youngson E, Bakal JA, Kaul P, Ezekowitz J, van Walraven C. Impact of physician continuity on death or urgent readmission after discharge among patients with heart failure. CMAJ 2013; 185 E681–9.
| Impact of physician continuity on death or urgent readmission after discharge among patients with heart failure.Crossref | GoogleScholarGoogle Scholar |
[4] Alqenae FA, Steinke D, Keers RN. Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review. Drug Saf 2020; 43 517–37.
| Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review.Crossref | GoogleScholarGoogle Scholar |
[5] Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 2003; 18 646–51.
| Medical errors related to discontinuity of care from an inpatient to an outpatient setting.Crossref | GoogleScholarGoogle Scholar |
[6] Li JYZ, Yong TY, Hakendorf P, Ben-Tovim D, Thompson CH. Timeliness in discharge summary dissemination is associated with patients’ clinical outcomes. J Eval Clin Pract 2013; 19 76–9.
| Timeliness in discharge summary dissemination is associated with patients’ clinical outcomes.Crossref | GoogleScholarGoogle Scholar |
[7] Belleli E, Naccarella L, Pirotta M. Communication at the interface between hospitals and primary care: a general practice audit of hospital discharge summaries. Aust Fam Physician 2013; 42 886–90.
[8] Hoyer EH, Odonkor CA, Bhatia SN, Leung C, Deutschendorf A, Brotman DJ. Association between days to complete inpatient discharge summaries with all-payer hospital readmissions in Maryland. J Hosp Med 2016; 11 393–400.
| Association between days to complete inpatient discharge summaries with all-payer hospital readmissions in Maryland.Crossref | GoogleScholarGoogle Scholar |
[9] van Walraven C, Seth R, Austin PC, Laupacis A. Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med 2002; 17 186–92.
| Effect of discharge summary availability during post-discharge visits on hospital readmission.Crossref | GoogleScholarGoogle Scholar |
[10] Australian Commission on Safety and Quality in Health Care (ACSQHC). National Safety and Quality Health Service Standards, 2nd edn – version 2. Sydney, Australia: ACSQHC; 2021. Available at https://www.safetyandquality.gov.au/sites/default/files/2021-05/national_safety_and_quality_health_service_nsqhs_standards_second_edition_-_updated_may_2021.pdf [accessed 10 April 2023].
[11] Australian Digital Health Agency. eDischarge summary v1.4. Sydney: Australian Digital Health Agency; 2012. Available at https://developer.digitalhealth.gov.au/specifications/clinical-documents/ep-1152-2012 [accessed 10 April 2023].
[12] The Royal Australian College of General Practitioners (RACGP). General Practice Health of the Nation 2022. 2022. Available at https://www.racgp.org.au/general-practice-health-of-the-nation-2022 [accessed 10 April 2023].
[13] Sarzynski E, Hashmi H, Subramanian J, Fitzpatrick L, Polverento M, Simmons M, et al. Opportunities to improve clinical summaries for patients at hospital discharge. BMJ Qual Saf 2017; 26 372–80.
| Opportunities to improve clinical summaries for patients at hospital discharge.Crossref | GoogleScholarGoogle Scholar |
[14] Bernal JL, DelBusto S, García-Mañoso MI, de Castro Monteiro E, Moreno Á, Varela-Rodríguez C, et al. Impact of the implementation of electronic health records on the quality of discharge summaries and on the coding of hospitalization episodes. Int J Qual Health Care 2018; 30 630–6.
| Impact of the implementation of electronic health records on the quality of discharge summaries and on the coding of hospitalization episodes.Crossref | GoogleScholarGoogle Scholar |
[15] Reinke CE, Kelz RR, Baillie CA, Norris A, Schmidt S, Wingate N, et al. Timeliness and quality of surgical discharge summaries after the implementation of an electronic format. Am J Surg 2014; 207 7–16.
| Timeliness and quality of surgical discharge summaries after the implementation of an electronic format.Crossref | GoogleScholarGoogle Scholar |
[16] Mehta RL, Baxendale B, Roth K, Caswell V, Le Jeune I, Hawkins J, et al. Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: a before and after study. BMC Health Serv Res 2017; 17 624
| Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: a before and after study.Crossref | GoogleScholarGoogle Scholar |
[17] van Walraven C, Rokosh E. What is necessary for high-quality discharge summaries? Am J Med Qual 1999; 14 160–9.
| What is necessary for high-quality discharge summaries?Crossref | GoogleScholarGoogle Scholar |
[18] van Walraven C, Duke SM, Weinberg AL, Wells PS. Standardized or narrative discharge summaries. Which do family physicians prefer? Can Fam Physician 1998; 44 62–9.
[19] Sorita A, Robelia PM, Kattel SB, McCoy CP, Keller AS, Almasri J, et al. The Ideal Hospital Discharge Summary: A Survey of U.S. Physicians. J Patient Saf 2021; 17 e637–44.
| The Ideal Hospital Discharge Summary: A Survey of U.S. Physicians.Crossref | GoogleScholarGoogle Scholar |
[20] Tremoulet PD, Shah PD, Acosta AA, Grant CW, Kurtz JT, Mounas P, et al. Usability of Electronic Health Record-Generated Discharge Summaries: Heuristic Evaluation. J Med Internet Res 2021; 23 e25657
| Usability of Electronic Health Record-Generated Discharge Summaries: Heuristic Evaluation.Crossref | GoogleScholarGoogle Scholar |
[21] Bradley EH, Sipsma H, Horwitz LI, Curry L, Krumholz HM. Contemporary data about hospital strategies to reduce unplanned readmissions: what has changed? JAMA Intern Med 2014; 174 154–6.
| Contemporary data about hospital strategies to reduce unplanned readmissions: what has changed?Crossref | GoogleScholarGoogle Scholar |
[22] Hoffmann M, Schwarz CM, Pregartner G, Weinrauch M, Jantscher L, Kamolz L, et al. Attitudes of physicians towards target groups and content of the discharge summary: a cross-sectional analysis in Styria, Austria. BMJ Open 2019; 9 e034857
| Attitudes of physicians towards target groups and content of the discharge summary: a cross-sectional analysis in Styria, Austria.Crossref | GoogleScholarGoogle Scholar |
[23] Chemali M, Hibbert EJ, Sheen A. General practitioner understanding of abbreviations used in hospital discharge letters. Med J Aust 2015; 203 147
| General practitioner understanding of abbreviations used in hospital discharge letters.Crossref | GoogleScholarGoogle Scholar |
[24] Schwarz CM, Hoffmann M, Smolle C, Eiber M, Stosier BS, Pregartner G, Kamolz LP, Sendler G. Structure, content, unsafe abbreviations, and completeness of discharge summaries: A retrospective analysis in a University Hospital in Austria. J Eval Clin Pract 2021; 27 1243–1251.
| Structure, content, unsafe abbreviations, and completeness of discharge summaries: A retrospective analysis in a University Hospital in Austria.Crossref | GoogleScholarGoogle Scholar |
[25] Grimes TC, Duggan CA, Delaney TP, Graham IM, Conlon KC, Deasy E, et al. Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation. Br J Clin Pharmacol 2011; 71 449–57.
| Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation.Crossref | GoogleScholarGoogle Scholar |
[26] Perren A, Previsdomini M, Cerutti B, Soldini D, Donghi D, Marone C. Omitted and unjustified medications in the discharge summary. Qual Saf Health Care 2009; 18 205–8.
| Omitted and unjustified medications in the discharge summary.Crossref | GoogleScholarGoogle Scholar |
[27] Latimer S, Hewitt J, Teasdale T, de Wet C, Gillespie BM. The accuracy, completeness and timeliness of discharge medication information and implementing medication reconciliation: A cross-sectional survey of general practitioners. Aust J Gen Pract 2020; 49 854–8.
| The accuracy, completeness and timeliness of discharge medication information and implementing medication reconciliation: A cross-sectional survey of general practitioners.Crossref | GoogleScholarGoogle Scholar |
[28] Bonevski B, Magin P, Horton G, Foster M, Girgis A. Response Rates in GP Surveys: Trialling Two Recruitment Strategies. Aust Fam Physician 2011; 40 427–30.
[29] Stokes T, Tarrant C, Mainous III AG, Schers H, Freeman G, Baker R. Continuity of care: is the personal doctor still important? A survey of general practitioners and family physicians in England and Wales, the United States, and The Netherlands. Ann Fam Med 2005; 3 353–9.
| Continuity of care: is the personal doctor still important? A survey of general practitioners and family physicians in England and Wales, the United States, and The Netherlands.Crossref | GoogleScholarGoogle Scholar |
[30] Nulty DD. The adequacy of response rates to online and paper surveys: what can be done? Assess Eval High Educ 2008; 33 301–14.
| The adequacy of response rates to online and paper surveys: what can be done?Crossref | GoogleScholarGoogle Scholar |
