Emergency Care Discharge Standard

Emergency Care Discharge Standard

Nearly two million people attend emergency care services each month. Sharing discharge information between emergency care and GP practices is essential for ensuring patient safety and good ongoing treatment. Relevant and useful information must be transferred quickly to GPs and their clinical teams, reducing the risk of transcription errors and improving the patient experience.

The NHS Long Term Plan  sets out the digital plan for the NHS which includes greater use of electronic systems and shared care records to support person-centred care, ensuring clinicians have access to the information they need to provide high quality care in health services.

On this page

Current release

Version: v2.2
> Standard model – Excel
> Supporting documentation (external link to NHS Standards Directory)

From 01 January 2026, this standard will be owned and managed by NHS England and is made available for reuse or amendment under the Open Government Licence v3.0 (OGL 3.0). A review of the ongoing requirement for this standard will be undertaken by NHS England. Details on this and any update to the standard will be published on the NHS Standards Directory. If you have any questions or feedback relating to this standard, please email: england.standards.assurance@nhs.net.

 

About this standard

The standard defines the information content and structure that should be used to create an emergency care discharge. It is designed for sending coded and structured electronic discharges which can be transferred to primary care and other systems and used to populate their record systems. Full electronic transfer will improve safety through reducing the risk from re-typing information and make that information fully available in the receiving electronic record systems more quickly. It can also be used for paper or electronic documents, although some of the benefits will not be realised in doing this.

The expected benefits from implementing the standards are:  

  • Improved patient safety by:
    • having information which is needed for safe continuity of care available on a timely basis
    • avoiding transcription errors when medication information is electronically transferred to the GP record (following clinician review), without the need for re-entry.
  • Improvements to patient care and patient satisfaction by:
    • having consistent and timely information (including medications, diagnoses, procedures and allergies) transferred to all relevant care professionals and their GP practice  
    • providing patients with legible up to date information about their stay in hospital.
  • Support for new more integrated and person-centred ways of working, including:
    • increased efficiency for multidisciplinary teams by providing structured and coded information on diagnoses, procedures and medications which can be reused for new ways of integrated working across health and care.
  • Time savings for NHS organisations by:
    • Avoiding the need to re-type information into the GP record
  • Increased opportunity for future development of patient led care by ensuring interoperability between multiple systems, including personal health records. 

The standard is evidence based and developed through extensive consultation with clinicians, professionals and people across health and care involved with hospital discharge. Full details of how it was developed are available in the final report in the supporting documentation.  

Summary table

The hospital electronic patient record (EPR) is expected to be able to generate much of the discharge summary from information recorded in the record such as attendance details, diagnoses, procedures, medications, patient demographics and other administrative information, with the person completing the record adding other information such as the clinical summary, plan and requested actions. Some examples to help visualise the standard are shown below.  

The standard comprises 18 sections, 10 mandatory (must be included), 8 required (should be included where the information is available), 0 optional (local choice whether to include the information).  These are shown in the summary table below:

SectionDescriptionMRO*
GP practiceDetails of the GP practice where the patient is registered.mandatory
Patient demographicsPatient details and contact information.mandatory
Attendance detailsThe details of the patient contact.mandatory
Referrer detailsDetails of the individual or team who referred the patient.required
Presenting complaints or issuesThe description of the health problems and issues experienced by the patient resulting in their attendance.mandatory
Clinical narrativeA brief description of the encounter.mandatory
DiagnosesA list of the patient’s diagnoses.mandatory
ProceduresThe details of any procedures performed.required
Medications and Medical DevicesThe details of and instructions for medications and medical equipment the patient is using.required
Allergies and adverse reactionsThe details of any known allergies, intolerances or adverse reactions.required
RisksThe details of any risks the patient poses to themselves or others.required
SafeguardingDetails of any identified safeguarding concerns.required
Discharge detailsThe details of the patient’s discharge from emergency care.required
Information and advice givenA record of any information or advice given to the patient, carer or relevant third party.mandatory
Distribution listSectionrequired
Plan and requested actionsThe details of planned investigations, procedures and treatment, and whether this plan has been agreed with the patient or their legitimate representative.mandatory
Person completing recordThe details of the person who filled out the record.mandatory
Senior reviewing clinicianThe details of the senior clinician who reviewed the record.mandatory
Contact for further informationDetails of a contact who can provide further information.mandatory

Examples

To give a clearer idea of how the standard works in practice, PRSB have created the following example letters.

Endorsement

  • ADASS – Association of Directors of Adult Social Services
  • Care Providers Alliance
  • Royal College of Emergency Medicine
  • Royal College of General Practictioners
  • Royal College of Nursing
  • Royal College of Occupational Therapists
  • Royal College of Physicians
  • Royal College of Psychiatrists
  • Royal College of Radiologists
  • Royal Pharmaceutical Society
  • Institute of Health Records and Information Management
  • Tech UK

Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.