A new review of existing practice and policy, led by experts at the University of Nottingham, has highlighted the need to improve hospital doctors' understanding of how GPs operate as 'expert generalists' as the key to tackling long-term issues around communication at hospital discharge.
When patients leave hospital, their GP receives a discharge summary to assist with their ongoing care. Missing information can affect the safety and quality of future care that the GP can provide and even lead to avoidable harm. Over 40 million summaries are produced every year in the English NHS, meaning that even small improvements could have significant effects.
Since the mid 2000's, hospitals have been encouraged to use summary templates with standard headings to improve their quality. This has helped in many ways, but research shows that a 'one-template-fits-all' approach does not always work well for the GPs who receive and use the summaries.
The development paper, led by Dr Nicholas Boddy in the School of Medicine – and supported by the National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration (NIHR GM PSRC) – acknowledges that although standard templates have improved discharge summaries, communication needs to become more orientated to the patient's future care to achieve further progress.
The article, published in the journal Primary Health Care Research & Development this week, describes some of the key foundations for advancements, which need to be built upon with new research and later developed with patients, hospital and community staff.
Dr Boddy, who is a NIHR In-Practice Fellow in the Centre for Academic Primary Care at the University of Nottingham's School of Medicine, and a practicing GP, said:
Standardised templates can lead to important details being left out, especially for patients with more complex health needs. For example, GPs often need to know not just what happened in hospital, but why certain decisions were made, what the patient's views were, and how treatments are expected to work in future."
The paper – written with co-authors Anthony Avery, Professor of Primary Health Care in the School of Medicine, and colleagues from the Universities of Hull and Warwick – argues for a more future-focussed, 'purpose-driven' approach to writing discharge summaries. This means considering what the summary will be used for and tailoring the content to the patient's future care.
Dr Boddy adds: "Too little information can put patients at risk, while too much irrelevant detail can also be unhelpful: the GP may have very limited time to read the summary. To find the right balance of information, hospital doctors writing the summaries will need a strong understanding of what GPs (and other community-based clinicians) will want to know, and how generalist care differs from specialist hospital care.
"Improving this understanding can be difficult, and so more feedback, new training sessions, and placements that combine community and hospital work could help. New guidance that helps authors to look beyond the standard headings will also be very important.
"The overall picture shows that standardised templates have improved discharge summaries, but the next step is to encourage communication to become more tailored to the patient's future care. Hospital teams will need to understand the GP's perspective better to do this effectively."
The full paper can be found here.
