Discharge data getting worse – Alliance

The discharge summary target

The NHS Alliance says hospital discharge information has got worse over the past three years, based on the results of its latest nationwide survey of GPs.

The survey found 57% of responding GPs had seen patient safety put at risk in the past year because of poor discharge information. And seven out of ten doctors reported that clinical care had been compromised because discharge information was late, incomplete or both.

The survey is the 4th nationwide survey carried out by the NHS Alliance and the organisation said the responses to these two measures had deteriorated over the past three years.

While in 2007 21% of GPs said they had never seen instances where patient safety had been compromised by inadequate discharge information, only 6% of GPs in 2010 reported that they have never seen patient safety compromised.

In addition, while 58% of GPs in both 2007 and 2008 said clinical care had been compromised by poor discharge information, by 2010 that figure had grown to 70%.

The Alliance said the most common risk to safety was incomplete or inaccurate information about medication.

It said it was the daily experience of many doctors that hospitals do not tell them what medication has been prescribed, what the dosage is, what medication has been stopped and the reasons why.

The Alliance report adds: “We have been told of patients whose prescribed warfarin has been stopped, with no advice to either patient or GP on discharge.

"More commonly, the GP is not advised when warfarin has been started during in-patient treatment. Several of our respondents have told us this has led to urgent and avoidable re-admissions.”

Hospitals have faced increasing pressure to deliver timely and accurate discharge data and have had national contractual obligations to deliver discharge summaries within 48 hours by April 2009 and 24 hours by April 2010.

The vast majority of NHS trusts, however, are thought to be failing to meet the 24 hour requirement, with many also missing the 48 hour deadline.

The Alliance said one in three GPs were now receiving discharge summaries within 48 hours. However, it added that timeliness was not the only issue. It expressed fears that a focus on time meant content was being further neglected.

The Alliance says that one GP reported concerns about an electronic discharge letter (EDL) agreed between the local acute hospitals and the PCT in which many fields were optional, with no field at all for quantities dispensed.

The report adds: “This GP is so worried that the EDL itself will lead to safety risks that he has reported his concerns to the National Patient Safety Agency and the strategic health authority as well as the PCT. None of these bodies appear to be interested.”

Dr Mike Dixon, chairman of the NHS Alliance, said: “Punctuality is essential but it is not sufficient. We have found that critical information about medicines and diagnostic tests is missing or inaccurate. That can put patients at risk and lead to avoidable re-admission to hospital

“We are now calling on the Department to take action again to ensure hospitals understand that providing medical information to their patients’ GPs is a vital part of their role.”

The survey also found that only half of GPs reported receiving information that was complete or accurate. And when asked about the past three years, nine out of ten said clinical care had been compromised and 77% said patients’ safety had been put at risk.

The Alliance, whose membership included GP practices and primary care trusts, carried out its survey of discharge information in February when the national standard contract required hospitals to provide discharge information to GPs within 48 hours.

Its survey covered 124 GP practices from 67 PCTs covering all ten strategic health authorities. Its previous discharge information surveys were carried out in 2005, 200-7 and 2008.