Discharge communication from inpatient care: an audit of written medical discharge summary procedure against the new National Health Service Standard for clinical handover
Daniel Brooks Reid A D , Shaun R. Parsons A , Stephen D. Gill B and Andrew J. Hughes CA Deakin University, School of Medicine, 75 Pigdons Road, Waurn Ponds, Vic. 3216, Australia. Email: sparsons@deakin.edu.au
B Barwon Health, PO Box 281, Geelong, Vic. 3220, Australia. Email: steveg@barwonhealth.org.au
C Department of General Medicine, Geelong Hospital, Deakin University and Barwon Health, Ryrie Street, Geelong, Vic. 3220, Australia. Email: andrewhu@barwonhealth.org.au
D Corresponding author. Email: dbrooksr@deakin.edu.au
Australian Health Review 39(2) 197-201 https://doi.org/10.1071/AH14095
Submitted: 17 June 2014 Accepted: 29 October 2014 Published: 11 December 2014
Abstract
Objective To audit written medical discharge summary procedure and practice against Standard Six (clinical handover) of the Australian National Safety and Quality Health Service Standards at a major regional Victorian health service.
Methods Department heads were invited to complete a questionnaire about departmental discharge summary practices.
Results Twenty-seven (82%) department heads completed the questionnaire. Seven (26%) departments had a documented discharge summary procedure. Fourteen (52%) departments monitored discharge summary completion and 13 (48%) departments monitored the timeliness of completion. Seven (26%) departments informed the patient of the content of the discharge summary and six (22%) departments provided the patient with a copy. Seven (26%) departments provided training for staff members on how to complete discharge summaries. Completing discharge summaries was usually delegated to the medical intern.
Conclusions The introduction of the National Service Standards prompted an organisation-wide audit of discharge summary practices against the external criterion. There was substantial variation in the organisation’s practices. The Standards and the current audit results highlight an opportunity for the organisation to enhance and standardise discharge summary practices and improve communication with general practice.
What is known about the topic? The Australian National Safety and Quality Health Service Standards (Standard 6) require health service organisations to implement documented systems that support structured and effective clinical handover. Discharge summaries are an important and often the only form of communication during a patient’s transition from hospital to the community. Incomplete, inaccurate and unavailable discharge summaries are common and expose patients to greater health risks. Junior staff members find completing discharge summaries difficult and fail to receive appropriate education or support. There is little published evidence regarding the discharge summary practices of inpatient health services.
What does this paper add? The paper demonstrates that there is substantial variation in practice regarding discharge summaries in a large regional health service. Departments have different processes and vary in the degree of attention and quality assurance provided to discharge summaries. Variable organisation procedures make completing discharge summaries more difficult for junior doctors, who regularly move between departments. Variable practice is likely to increase the risk of absent, untimely, incomplete or incorrect communication between acute and community services, thereby reducing the quality of patient care. It is likely that similar findings would be found in other hospitals.
What are the implications for practitioners? To be accredited under the National Safety and Quality Health Service Standards, health organisations must ensure that adequate processes are in place for safe and effective clinical handover. Organisations should reduce the practice variability by standardising processes, monitoring compliance with processes, and training and supporting junior doctors.
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