Abstract
Introduction
A good discharge summary for a patient is an important clinical record that narrates and communicates clinical information about the patient's entire hospitalisation. Discharge communications between healthcare facilities play a pivotal role in the coordination of patient care. As geriatric patients’ physical health is intricately woven into their social circumstances, mobility, and available care facilities, the mention of these parameters becomes quite important as it informs the community medical team of the patient’s condition more comprehensively. Crafting a good summary is challenging and we noted insufficient documentation of geriatric domains.
Methods
A discharge summary QIP was run in the geriatric wards at the Royal Gwent Hospital for 5 cycles. In these 5 cycles, we introduced a poster, electronic MDT, teaching sessions, and discharge summary checklist respectively as our chosen intervention. We collected data prospectively and calculated the percentages of presenting complaints, diagnosis, comorbidities, history, examination findings, investigations, management, mobility, care needs, discharge destination, cognition, resuscitation and escalation plan, whether were documented or not in the summaries.
Results
A total of 20-30 patients’ discharges were included in each cycle. Overall, there was good documentation in general medical domains (95-100%). A remarkable rise in the documentation of care needs (65%), mobility (80%), and discharge destination (50%) amongst other parameters was noted. However, there was minimal improvement in cognition, resuscitation and escalation plans as some of them do not apply to all patients. The improvement is progressing as the physicians are now frequently referring to the checklist for writing the summaries.
Conclusion
These interventional measures showed the quality of discharge summaries has improved dramatically. Hence, we uploaded the discharge checklist to our health board intranet and included it in the induction booklet. We hope to include it in our yearly induction sessions to maintain the level of improvement.