eDischarge Summary Standard

Transfer of Care – Acute Inpatient Discharge Standard

The eDischarge Summary Standard enables hospitals to safely transfer accurate clinical information and coded data to GP surgeries, care homes and community services when a patient is discharged. It ensures all relevant information about the patient, including diagnoses, medications, procedures and allergies, is shared in order to improve the quality and consistency of care. Best practice is also to share the discharge summary with the patient.

On this page

Current release

Version: v2.1
> Standard model – Excel
> View documentation for this standard (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

This standard defines the information content and structure that should be used to create a hospital 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.

Benefits:

  • Patient safety:
    • Information needed for safe continuity of care available on a timely basis.
    • Avoiding transcription errors when medication information is electronically transferred to the GP record.
  • Patient care and patient satisfaction:
    • Consistent and timely information (including medications, diagnoses, procedures and allergies) transferred to care professionals and their GP practice.
    • Providing patients with legible up to date information about their hospital stay.
  • 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.

How to complete a discharge summary

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 diagnoses, procedures, medications, investigation results, assessments, patient demographics and other administrative information, with the person completing the record adding other information such as the clinical summary, plan and requested actions.

The standard comprises 22 sections, 6 mandatory (must be included), 10 required (should be included where the information is available), 6 optional (local choice whether to include the information). These are shown in the summary table below.

 

Transfer of Care – Acute Inpatient Discharge Standard summary table 
Section Description MRO*
Patient demographics Patient details and contact information. mandatory
GP practice Details of the GP practice where the patient is registered. mandatory
Referrer details Details of the individual or team who referred the patient. required
Social context The social setting in which the patient lives, such as their household, occupational history, and lifestyle factors. optional
Individual requirements Individual requirements that a person has, e.g. communication, cultural, cognitive, mobility needs and reasonable adjustments. required
Participation in research The details of any research studies the patient is participating in. optional
Admission details Details of the patient’s admission and reason for admission required
Discharge details The details of the patient’s discharge from hospital including discharge destination. required
Diagnoses A list of the patient’s diagnoses. mandatory
Procedures The details of any procedures performed. optional
Clinical summary A brief description of the episode of care. mandatory
Investigation results A record of investigations and procedures requested, results and plans. optional
Assessments A description of any assessments used. optional
Legal information Legal information captured relating to patient care, such as consent to sharing information, legal power of attorney, safeguarding issues and mental capacity. required
Safety alerts The details of any risks the patient poses to themselves or others. required
Medications and Medical Devices The details of and instructions for medications and medical equipment the patient is using. Includes changes in prescribed medications. optional
Allergies and adverse reactions The details of any known allergies, intolerances or adverse reactions. mandatory
Patient and carer concerns, expectations and wishes A description of the concerns, expectations or wishes of the patient. required
Information and advice given A record of any information or advice given to the patient, carer or relevant third party. required
Plan and requested actions Plans and requested actions for other healthcare professionals and the patient or their carer, including planned investigations, procedures and treatment. required
Person completing record The details of the person who filled out the record. mandatory
Distribution list A list of other individuals to receive a copy of this communication. required
*Conformance (MRO) Conformance describes whether the element is mandatory (MUST be recorded or shared), required (SHOULD be recorded or shared if available) or optional (MAY be recorded or shared). These rules apply to the person recording or sharing the information.

For full implementation the discharge information should be sent as electronic message using the NHS standard for messaging, HL7 FHIR, detailed here: Transfer of Care message specifications – NHS England

 

Examples

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

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”