scholarly journals Reaching the summit of discharge summaries: a quality improvement project

2021 ◽  
Vol 10 (1) ◽  
pp. e001142
Author(s):  
Richard Thomas Richmond ◽  
Isobel Joy McFadzean ◽  
Pramodh Vallabhaneni
Keyword(s):  
Quality Improvement ◽  
Health And Safety ◽  
Improve Patient Care ◽  
Discharge Summary ◽  
Shop Floor ◽  
Junior Doctors ◽  
Improvement Project ◽  
Step Model ◽  
Assessment Unit ◽  
Discharge Summaries

BackgroundDischarge summaries need to be completed in a timely manner, to improve communication between primary and secondary care, and evidence suggests that delays in discharge summary completion can lead to patient harm.Following a hospital health and safety review due to the sheer backlog of notes in the doctor’s room and wards, urgent action had to be undertaken to improve the discharge summary completion process at our hospital’s paediatric assessment unit. It was felt that the process would best be carried out within a quality improvement (QI) project.MethodsKotter’s ‘eight-step model for change’ was implemented in this QI project with the aim to clear the existing backlog of pending discharge summaries and improve the timeliness of discharge summary completion from the hospital’s paediatric assessment unit. A minimum target of 10% improvement in the completion rate of discharge summaries was set as the primary goal of the project.ResultsFollowing the implementation of the QI processes, we were able to clear the backlog of discharge summaries within 9 months. We improved completion within 24 hours, from <10% to 84%, within 2 months. The success of our project lies in the sustainability of the change process; to date we have consistently achieved the target completion rates since the inception of the project. As a result of the project, we were able to modify the junior doctor rota to remove discharge summary duty slots and bolster workforce on the shop floor. This is still evident in November 2020, with consistently improved discharge summary rates.ConclusionQI projects when conducted successfully can be used to improve patient care, as well as reduce administrative burden on junior doctors. Our QI project is an example of how Kotter’s eight-step model for change can be applied to clinical practice.

10 Improving Communication About Death Between Primary and Secondary Care: A Quality Improvement Project

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Arumugam ◽  
R Laud ◽  
P Naydenova
Keyword(s):  
Quality Improvement ◽  
Discharge Summary ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Improvement Project ◽  
Lack Of Information ◽  
Discharge Letter ◽  
Death Notification ◽  
Electronic Discharge Summary ◽  
Hospital Teams

Abstract Introduction Communication between the hospital and primary care regarding the death of a patient is incredibly important. Previous literature surrounding this area has shown that it is often done poorly, resulting in substandard documentation. Furthermore, lack of information for General Practitioners (GPs) means it is difficult for them to enter discussions with families, which can negatively impact on the bereavement process. The previous expectation was that an electronic discharge summary was completed, but that this was not optimally designed to inform GPs about the circumstances surrounding the death. Reasons given that summaries were not completed included: the busy workload of junior doctors and the lack of awareness of their importance. Methods The aim of our quality improvement project was to ensure 80% of GPs received notification and information about a patient’s death by August 2018. Following an initial cycle to assess the baseline notification rates, we developed a standardized death notification letter following feedback from local GPs. This included information such as date of death, if the coroner had been informed and a brief summary of events. Following introduction of the letter, we recorded the uptake and then gained further feedback regarding the ways in which it could be improved. A final cycle was then implemented. Results Baseline data showed an electronic discharge letter was only being completed in 13.3% of cases (n=3/21). Following introduction of the new letter, 83.6% were completed (n=56/67). Conclusions In conclusion, the introduction of a simple and standardized letter template has vastly increased the notification of GPs about a patient’s death from our hospital. Limitations of our project included the varying numbers of deaths in audited periods and some hospital teams having a separate process in place.

scholarly journals A quality improvement project on the discharge summary completion process in an addictions service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S209-S209
Author(s):  
Lily Mohamed
Keyword(s):  
Quality Improvement ◽  
Compliance Rate ◽  
Primary Care Providers ◽  
Discharge Summary ◽  
Quality Improvement Project ◽  
Health Board ◽  
Care Providers ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Discharge Summaries

AimsDischarge summaries are vital documents that communicate information from hospital to primary care providers. The documents contain description of the patient's diagnostic findings, hospital management, laboratory results, medications list and arrangements for post-discharge follow-up. Ineffective communications between healthcare providers in the form of delayed or poor quality discharge summary may adversely affect patient care and safety.The setting of this project is Gwent Specialist Substance Misuse Service (GSSMS) which is the statutory specialist addictions service within Aneurin Bevan University Health Board (ABUHB). GSSMS has been arranging and managing inpatient alcohol detoxes for many years. One of the issues highlighted by an inpatient alcohol detox audit in 2017 was discharge summaries were not being completed for every patient who was admitted with a compliance rate of only 57.7%. A quality improvement project was initiated following the presentation of the audit on a Staff Education Day.The aim of the project is to increase the discharge summary completion rate from 57.7% to 80% by June 2019.MethodA discharge summary process map was developed to understand the possible causes of delay then Plan, Do, Study, Act (PDSA) methodology was utilised. The result of the original audit was taken as the baseline measurement and benchmarking activities and PDSA cycle were performed. Interventions included root cause analysis by way of brainstorming, education, communication and constructing a checklist.ResultThere has been significant improvement with the compliance rate following the PDSA cycle. It went up to 100% before tapering off to 85% by the end of the project.ConclusionAwareness building, continuous monitoring and engagement of teams alongside regular feedback were shown to be the important factors to achieve and sustain the improvement.

scholarly journals A quality improvement project to improve the number of section 136 GP discharge summaries from the place of safety

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S192-S192
Author(s):  
Jemma Hazan ◽  
Mikail Ozer ◽  
Yathooshan Ramesh ◽  
Richard Westmoreland
Keyword(s):  
Quality Improvement ◽  
Discharge Summary ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Time Period ◽  
Progress Notes ◽  
Number Of Patients ◽  
Management Plans ◽  
Discharge Letter ◽  
Discharge Summaries

AimsA Quality Improvement project with the aim to increase the number of patients discharged with a GP discharge summary from the Chase Farm Place of Safety over a 12 month time period by 50%.BackgroundAn initial audit was conducted at Chase Farm Place of Safety (POS) to see if patients held under Section 136 of the Mental Health Act (S136) and then discharged home had a GP discharge letter completed and sent. The audit revealed that 0.02% of patients who were under S136 and discharged home did have a discharge letter sent to the GP.As a result of the initial audit, key stakeholders were contacted, and involved in the intervention design and implementation. The intervention was introduced and all doctors working in the trust were emailed the new protocolMethodWe implemented the following intervention:If a patient was registered at a GP Practice then the nursing staff in the POS copied the entry of the discharging doctor from the electronic progress notes and pasted this in to the S136 discharge template on the electronic progress notes and this was emailed to the GP.We informed Doctors to be aware that their entry would go out to the GP and should contain the following: Impression, Outcome/Plan, Specific Risk /Safeguarding concerns and specific management plans.ResultIn the initial audit the notes of all patients discharged from the POS under S136 were reviewed over a 3 month period between November and January 2018. We found that 2 out of 89 patients (0.02%) had a completed GP summary which was emailed to the GP Practice.After the intervention was introduced the notes were audited between July and September 2019. We found 33 out of 60 patients (55%) had a completed GP summary which was emailed to the GP Practice.ConclusionThere was an improvement of 54.8% in the number of discharge summaries. Further consideration needs to be given to improving this percentage and understanding what remaining barriers there are.

261 Using Technology to Improve Inpatient Surgical Lists

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Gowda ◽  
Z Chia ◽  
T Fonseka ◽  
K Smith ◽  
S Williams
Keyword(s):  
Quality Improvement ◽  
Patient Care ◽  
Junior Doctors ◽  
Research Projects ◽  
Point Scale ◽  
Improvement Project ◽  
Surgical Department ◽  
Team Meetings ◽  
And Training ◽  
Multi Disciplinary Team

Abstract Introduction Every day in our surgical department; prior to our quality improvement project, Junior Doctors spent on average 3.26 clinical hours maintaining 5 surgical inpatient lists of different specialities with accessibility of lists rated as “neutral” based on a 5-point scale from difficult to easy. Our hospital previously had lists stored locally on designated computers causing recurrent difficulties in accessing and editing these lists. Method We used surveys sent to clinicians to collect data. Cycle 1: Surgical Assessment Units list on Microsoft Teams Cycle 2: Addition of surgical specialities and wards lists onto Microsoft Teams. Cycle 3 (current): expand the use of Microsoft Teams to other specialities. Results Utilising technology led to a 25% reduction in time spent on maintaining inpatient lists, to 2.46 hours a day, and an improvement in the accessibility of lists to “easy”. Across a year, this saves over 220 hours clinician hours which can be used towards patient care and training. Furthermore, use of Microsoft Teams has improved communication and patient care, in the form of virtual regional Multi-Disciplinary Team meetings and research projects. Conclusions Microsoft Teams is currently free to all NHS organisations in England so there is potential for these efficiency savings to be replicated nationwide.

Independent Prescribing Pharmacists Supporting the Early Discharge of Patients Through Completion of Medical Discharge Summaries

2018 ◽  
Vol 33 (2) ◽  
pp. 173-175 ◽  
Author(s):  
Martin J. Biggs ◽  
Timothy C. Biggs
Keyword(s):  
Hospital Discharge ◽  
Medication Errors ◽  
Early Discharge ◽  
Discharge Summary ◽  
Medical Decision ◽  
Junior Doctors ◽  
Allied Health Professionals ◽  
Independent Prescribing ◽  
Discharge Summaries ◽  
Improve Service Delivery

Purpose: Independent prescribing pharmacists are able to independently prescribe medications following additional postgraduate training. This study examined their use in completing medical discharge summaries, normally completed by junior doctors, in order to assess their impact on expedited hospital discharge times. Methods: In total, 163 patients were studied through a 2-stage audit. The first cycle evaluated junior doctors completing medical discharge summaries (as is normal practice). Three independent prescribing pharmacists were then trained to complete discharge summaries, and a second cycle was completed. Results: Following implementation of independent prescribing pharmacists to complete medical discharge summaries, the time from medical decision to discharge to summary completion dropped significantly (mean of 2:42 hours to 1:35 hours, P < .001). The time from medical decision to discharge to actual hospital discharge also dropped significantly (mean of 5:21 hours to 3:58 hours, P < .01). The number of discharge summary medication errors dropped significantly ( P < .05) between audit cycles. Conclusion: The introduction of independent prescribing pharmacists to complete medical discharge summaries has significantly reduced the time to summary completion, discharge time, and the number of medication errors. In a time of limited medical resources and bed shortages, the use of allied health professionals to improve service delivery is of paramount importance. This project is the first of its kind within the literature.

EP.TU.281Mind the Gap: Improving the Quality of Neurosurgical Discharge Summaries

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Yagmur Esemen ◽  
Micaela Uberti ◽  
Navneet Singh ◽  
Andreas Karamitros
Keyword(s):  
Formal Education ◽  
Discharge Summary ◽  
Ward Round ◽  
Junior Doctors ◽  
Care Providers ◽  
Essential Components ◽  
Visual Aid ◽  
Primary Means ◽  
Discharge Summaries

Abstract Aims A discharge summary is a permanent record of a patient’s hospital visit and the primary means of handover between care providers. Studies show they often lack precision and omit important information. This may compromise quality and continuity of care yet they are frequently written by the most junior clinicians on a ward with little guidance or formal education on how to write one. The aim of this study was to develop some specific guidelines to improve the quality of discharge summaries in a busy neurosurgical unit. Methods A survey was designed to identify the challenges faced by junior medical staff in writing discharge summaries. The essential components of a good neurosurgical discharge summary were identified by group of senior neurosurgeons. Summaries were retrospectively audited against these components. We then designed a simple visual aid and placed it above computer stations in the junior doctors’ offices. Formal departmental teaching session followed. After three months we re-audited the discharge summaries retrospectively to measure any effect of our intervention. Results Half of the neurosurgical team rated summaries as below expectations. Challenges included poor ward round documentation and a lack of clear expectations regarding structure and essential components. After the intervention, ward round documentation and discharge summary quality improved dramatically. Conclusions Although various recommendations about writing good discharge summaries exist, they are generally vague and not specific to neurosurgical practice. The development of a simple specialty specific discharge summary guide can improve discharge summary quality and should be encouraged in all specialties.

524 QUALITY IMPROVEMENT PROJECT: INCORPORATING COMPREHENSIVE GERIATRIC ASSESSMENT INTO COMMUNITY HOSPITAL CLERKING

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
A Oates
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Community Hospital ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Medical Team ◽  
Improvement Project ◽  
Efficient Detection ◽  
User Friendly

Abstract Elderly patients transferred to community hospitals often have complex medical, social, psychological, functional and pharmacological backgrounds that require careful assessment in order to create and deliver a high quality, patient-centred care plan. Unfortunately, time pressures experienced by staff in acute hospitals can make Comprehensive Geriatric Assessment (CGA) unfeasible for every patient. Moreover, junior members of the medical team may be unsure as to which aspects of a patient’s background and presentation constitute important elements of a CGA. Failure to recognise and document pertinent issues can lead to prolonged admissions, disjointed care and failed discharges. Admission to a community hospital presents a convenient ‘checkpoint’ in the patient’s hospital journey at which to undertake a CGA. Recording the relevant information in an effective clerking proforma when the patient is admitted ensures that this information is displayed clearly and in a way that is accessible to all members of the multidisciplinary team. The pre-existing clerking proforma at Amersham Community Hospital omitted several important elements of CGA (such as examination of feet and gait, assessment of mood, FRAX-UK score, creation of a problem list etc.) The aim of this quality improvement project was to create a thorough, yet user-friendly and time-efficient clerking proforma which incorporated the important components of CGA. Using BGS guidance and NICE quality standards, alongside suggestions from the medical team, the existing clerking proforma was adapted and reformed. After one month, feedback from the team was used to further improve the clerking proforma, ensuring that it was user-friendly, whilst meeting the standards set out by NICE and BGS. This was repeated as part of a second PDSA cycle. The improved clerking proforma enables junior doctors to undertake a thorough and holistic assessment, promoting efficient detection of issues and the delivery of a higher quality of care.

Sign in / Sign up

Export Citation Format

Share Document