Discharge summary communication from secondary to primary care

Studies were conducted in Nottingham, UK to assess quality of discharge summary communication sent from secondary to primary care using updated processing methods. Objectives (1) Assess available evidence on effectiveness of interventions aiming to improve discharge information communication specifically introducing computerised discharge summaries (2) Assess differences in discharge summary quality using new processing methods (3) Obtain perspectives of secondary care on discharge communication issues, identifying points of weakness and primary care views on discharge information communicated from hospital. Methods (1) Systematic review of literature on effectiveness of interventions aiming to improve discharge summary information communication (2) Before and after studies of two different discharge summary types in three departments within Nottingham University Hospitals NHS Trust (3) Qualitative interviews with key stakeholders (N=27) and observations in 3 sites. Results The systematic review returned 21 interventions with emphasis on the introduction of computerised systems to improve quality (timeliness and completeness of discharge summaries). Nine studies significantly improved the completeness of the discharge summary. Ten studies significantly increased the timeliness of the generation of the document and the transfer of information. The three before and after studies produced varying results; the HCOP findings suggested improvements post-intervention in completeness of summaries; this was not statistically significant. In Nephrology, computerisation significantly speeded up the timeliness of discharge summaries but there was no significant difference in completeness between the two types. In Paediatrics, computerisation increased the number of summaries not completed, and the handwritten summary was significantly faster. Computerised discharge summaries contained more information- this was statistically significant. The qualitative study identified issues with understanding the concept of discharge, the purpose and importance of the discharge summary, and organisational issues around the ability to balance the demands for completeness and timeliness, a lack of leadership and user-centred design of the electronic discharge system. Conclusions The literature reviewed found examples of the potential computerisation has on discharge documentation quality. The research studies conducted showed that the introduction of computerisation into the discharge documentation process produced mixed results in quality (completeness and timeliness) of discharge summaries communicated from secondary to primary care. Slight improvements were found in the before and after studies and staff feedback was positive. The success of such interventions depends largely on increased clinical leadership and user-centred design. An established link to patient safety is needed to increase awareness of the importance of discharge summary communication and justify major system change