Concerns were raised at a GP Sub-committee meeting about the length of time it was taking for final discharge letters to be received. Several examples were given of letters being received over six weeks after discharge and there were concerns expressed that this was affecting patients' ongoing care and patient safety, as patients were often returning to see GPs before the GP had details of their recent hospital admission.
Immediate discharge letters were being promptly completed but these often only included details of medication and clinical information was limited as they were usually completed by the on call junior doctor. SIGN 128 standards for both the Immediate (Core) and the Final (Extended) Discharge Document were reviewed. The standard expected for the Final (Extended) Discharge Document is that the 'EDD should be sent out within seven days of the date of discharge to ensure that the GP has all the information required for the ongoing care and management of the patient. In cases where important information, such as test results, is not available within seven days, dispatch of the EDD can be delayed until the information is available but this delay should not exceed 14 days'.
It was agreed that a standard of 14 days would be appropriate locally as the final discharge letter could be delayed to allow the results of investigations to be included.
Implementation of the guidance was the responsibility of the Clinical Directors and they were given regular feedback on their performance. Delays in typing up letters were flagged up to the Head of Medical Records who also coordinated collection of Audit data. Regular feedback on performance has been given to the GP subcommittee and it is a standing item at the Associate Medical Directors meeting chaired by the Medical Director.
There were several interventions during the course of the audit, the main ones being reminding junior and senior doctors of the expectations to dictate and verify letters promptly. Guidelines were produced for medical administration on escalation when letters had not been dictated or verified within five working days and there was an intervention using LEAN methodology supported by Healthcare Improvement looking at streamlining the system.
Audit Of Discharge Letters
Date updated: 26/04/2021
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This page was last updated on: 03/05/2021