Hospitals taking measures to improve discharge summaries for patients

28th July 2017

New research shows Barking, Havering and Redbridge University Hospitals Trust are taking measures to improve discharge summaries for patients.

A three month audit was undertaken to review the existing quality of heart failure discharge summaries from Barking, Havering and Redbridge University Hospitals Trust.

Plans are now in place to introduce a 10 point checklist (providing specific guidance on what to include when composing an optimal heart failure discharge summary) for doctors to follow when assessing patients. This was found to be particularly useful and supportive for junior doctors.

Essentially, the aim of discharge summaries is to share clinical information about a patient’s hospital experience with their GP and other healthcare professionals responsible for providing continuing care. 

The results of the audit showed:

  • 164 individual patient episodes were identified from Hospital Episode Summary data as being discharged between 23 October 2014 and 22 January 2015. 
  • Thirteen patients were excluded: nine had no diagnostic imaging to verify a diagnosis of heart failure
  • Clinical notes could not be obtained for three patients
  • One patient was transferred as an inpatient to another Trust and ultimately discharged by that Trust
  • The remaining 151 patient episodes had a review of the clinical notes, imaging and electronic discharge summaries by a consultant cardiologist. There were 43 patients (28%) found not to have a primary diagnosis of heart failure after specialist review of case notes. In these cases, the clinical notes, blood tests, radiological and echocardiographic evidence supported an alternate non-cardiac cause for the admission. 
  • Alternate diagnoses incorrectly coded as heart failure included: chest infection/pneumonia, chronic obstructive pulmonary disease, pulmonary embolism, pulmonary fibrosis, fluid overload secondary to chronic lymphoedema, chronic kidney disease/nephrotic syndrome and chronic liver disease.

Researchers found from their analysis that more than a quarter of patients were incorrectly coded/diagnosed as heart failure. An inaccurate diagnosis or miscoding of heart failure can have serious consequences for both patients and hospital reimbursement. Being labelled with a chronic and potentially fatal diagnosis of heart failure can have an adverse psychological impact on the patient.

It can also misdirect clinical management by doctors with wrongful treatment, denial of potential life-saving access to intensive care, harm from inappropriate medication and failure to investigate the true cause of the patient’s symptoms. It is, therefore, crucial that clinicians be mindful of ‘over-diagnosing’ patients with heart failure when the history, clinical signs and investigations do not support it. The results also showed the overall standard of discharge summaries written without the benefit of a checklist was found to be very poor. More than a quarter of discharge summaries for heart failure had an incorrect primary diagnosis and important clinical details were often omitted.

The study concluded that a simple checklist would be cheaper and straightforward to implement. It also found that the new approach would improve the quality of the discharge summary and potentially contribute to better post hospital care.

Robert Hall, Support Nurse at Cardiomyopathy UK said: “The discharge summary is a crucial communication between the hospital and the patient’s GP and the information contained can inform many decisions regarding their future care. The inaccurate information the study revealed is concerning. The success shown by the introduction of a simple checklist showed an improvement in the quality of the summaries, which we hope other hospitals will take note of".