Hospital discharge notes lacking
Documentation sent to GPs when patients are discharged from hospital is often poor and this may lead to medication-related readmissions, a recent study suggests (Quality
and Safety in Health Care 2008;17:71).
A retrospective case-note review looked at 108 patients readmitted to
hospital as an emergency within 28 days of discharge. The researchers
found that documentation of changes in medication was incomplete on two
thirds of all discharge documents and that readmission was considered
drug-related in 38 per cent of cases.
Lead author Elizabeth Witherington, from the integrated discharge team
at Nottingham University Hospitals NHS Trust, City Hospital campus, and
a former GP, told The Journal that the study highlights the need for
improved written records in secondary care, particularly for older patients
with complex needs.
She said that even if a patient receives the best possible care in hospital,
if there is inadequate detail on discharge paperwork the patient’s
GP has no chance of assessing just how unwell the patient had been in
hospital, how soon they need to be followed up, or what additional monitoring
is required.
She added that there is often not a high enough level of suspicion that
a patient’s condition when they re-present to hospital might be
medicines-related.
Dr Witherington also drew attention to a new requirement within the NHS
contract for acute hospital services for 2008–09 (to apply from
April) that hospitals need to issue a discharge summary to the patient’s
GP within 72 hours.
However, she pointed out that foundation trusts on existing contracts
are not bound by this obligation.
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