eDischarge summaries – a guide

eDischarge summary standard - a video guide

A video guide looking at the importance of the eDischarge summary, how to complete a summary and feedback from junior doctors.

INTRODUCTION 

Completing a good discharge summary for a patient is essential for their ongoing treatment and care. They allow clinicians to provide key information for a patient’s next steps as they move around a hospital or are discharged back to their GP or outpatient clinic in the community. They make sure the right information is exchanged so that care is safe. 


There was an urgent need to improve patient safety and continuity of care by developing standardised e-discharge summaries. The eDischarge Summary Standard enables hospitals to safely transfer standardised clinical information using PRSB headings and coded data which can be extracted directly into GP IT systems.

HOW TO COMPLETE THE DISCHARGE SUMMARY

In this short training film, Tim Yates from the Royal Free Hospital guides us through the process of completing the hospital discharge summary form. Some of the key topics covered are listed below.

 

A mandatory field in the eDischarge summary must be completed. A required field should be recorded if you have the information available and is important to complete for the safety and care of the patient. It is your decision to complete information that is optional. An example of this is if you have requested an investigation or procedure.

Patient demographic information is an example of mandatory information that must be completed such as a patient’s name, date of birth and NHS number. You may also be asked to add some information that gives context such as the patient’s primary language and if they might need an intepreter.

It is important to make sure that all essential information is included so that it can be shared during discharge. There may be additional information about diagnoses that may not have been recorded on admission but is very important to share for the patient’s ongoing care after discharge. You must also make sure that any relevant co-morbidities are also up to date and recorded.

GP INDUCTION FILMS

GPs tell us that the discharge summary is often the only record they obtain of a patient’s hospital stay and a well-written discharge summary is invaluable. But in busy hospitals its importance is often overlooked.

Working in collaboration with GPs from the Lea Vale Medical Group, Bute House Medical Centre in Luton, Bedfordshire and Luton & Dunstable University Hospital, NHS Foundation Trust, we produced a series of videos that help to demonstrate why digitally shared information is so beneficial to patients and professionals.

“We are seeing the benefits of digital information sharing through discharge summaries, and I am keen for all trust professionals to recognise their importance” 
Amran Qurban, Head of GP Client Services, Luton & Dunstable University Hospital, NHS Foundation Trust.

Video Playlist
1/3 videos
1
INTRODUCTION
INTRODUCTION
2
BENEFITS TO GPS
BENEFITS TO GPS
3
THE CHALLENGES
THE CHALLENGES

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.