Electronic 24-hour discharge summary implementation
A standardised electronic discharge summary enables the continuous care of patients once they have been discharged from hospital, with consistent and relevant information in the right place, quickly.
Trusts may currently have multiple discharge summaries for different specialities, many of which are produced manually.
In August 2010, the Clinical Data Standards Assurance programme began a project to deliver a national, clinically-assured electronic Discharge Summary (DS), which focuses on the DS which is sent from an acute medical/surgical team to the GP within 24 hours of the patient being discharged.
This DS was intended to be structured, standardised and generic thus, having the ability to be sent electronically from any acute hospital electronic health record (EHR) system.
The basis of this work is the published Academy of Medical Royal College (AoMRC) DS headings. Using this and working with the Royal College of Physicians (RCP) and the Royal College of General Practitioners (RCGP), this project focussed specifically on meeting the DS needs of the GP and patient.
The output of the work, the toolkit, was produced to enable trusts to implement this work locally in a consistent manner, learning from the experiences of the trusts who worked on the project.
In doing this, trusts will take a step towards achieving their Commissioning for Quality and Innovation (CQUIN) targets and will ensure that patients and GPs are better informed about their care and any after care needed.
In the long term, this will improve the information provided to patients and create a better way of patients and GPs working together in an informed manner, and in turn could result in a reduction of readmissions.
The Discharge Summary Implementation Toolkit (PPS 16.4Mb) has been produced with the aim to help trusts implement the nationally-agreed Discharge Summary.
It gives an overview of the headings and case studies of trusts involved in the work, along with tips and lessons learned for any trust that is undertaking similar work.
Within the toolkit, there are links to:
- Materials and downloads provides further information on the Matrix and discharge summary mock up
- Film clips: watch videos to learn from NHS staff about benefits gained and tips for implementing the standard headings, plus endorsements for why a standardised, consistent Discharge Summary is one of the key factors in improving the quality of patient care in England.