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.
Current release
Version: V2.2 | |
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Release date | May 2023 |
Release notes | V2.2 |
Next release date | TBD |
Next release type | Scheduled release |
The standard | |
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Full standard – PRSB viewer | Available with next release |
Full standard – Excel |  |
Full standard – Json | Available with next release |
Supporting documentation | Description/purpose |
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FHIR technical specifications | The messaging specification for exchanging information using the NHS standard for messaging, HL7 FHIR. |
Implementation guidance | This document includes general implementation guidance for all PRSB standards and detailed guidance, specific to the eDischarge Summary Standard. |
Business rules (available with next release) | Rules for implementation of the standard. |
Final report | Describes the purpose, methodolgy and stakeholder engagement for developing the standard, along with the findings and recommendations for further work. |
Safety case | Summarises the hazards which could result from implementing the standard. |
Hazard log | Details the potential hazards from implementing the standard with their risk rating and mitigation. |
Need implementation support?
- Online support form
- Support@theprsb.org
- 020 4551 5225 (9-5 Mon-Fri, excl. bank holidays)
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.
Scope
Discharge after any admission to a type 1, 2 or 3 emergency care unit.
Out of scope:
- Discharge from hospital after any inpatient stay, including day cases – refer to the eDischarge Summary Standard – PRSB (theprsb.org)
- Discharge after mental health inpatient stay – refer to the Mental Health Inpatient Discharge Standard – PRSB (theprsb.org)
- Transfer between hospitals – although much of the content may be appropriate
- Discharge from outpatient treatment or other community based period of treatment – refer to Outpatient Letter Srandard – PRSB (theprsb.org)
How it works
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:
| Section | Description | MRO* |
| GP practice | Details of the GP practice where the patient is registered. | mandatory |
| Patient demographics | Patient details and contact information. | mandatory |
| Attendance details | The details of the patient contact. | mandatory |
| Referrer details | Details of the individual or team who referred the patient. | required |
| Presenting complaints or issues | The description of the health problems and issues experienced by the patient resulting in their attendance. | mandatory |
| Clinical narrative | A brief description of the encounter. | mandatory |
| Diagnoses | A list of the patient’s diagnoses. | mandatory |
| Procedures | The details of any procedures performed. | required |
| Medications and Medical Devices | The details of and instructions for medications and medical equipment the patient is using. | required |
| Allergies and adverse reactions | The details of any known allergies, intolerances or adverse reactions. | required |
| Risks | The details of any risks the patient poses to themselves or others. | required |
| Safeguarding | Details of any identified safeguarding concerns. | required |
| Discharge details | The details of the patient’s discharge from emergency care. | required |
| Information and advice given | A record of any information or advice given to the patient, carer or relevant third party. | mandatory |
| Distribution list | Section | required |
| Plan and requested actions | The details of planned investigations, procedures and treatment, and whether this plan has been agreed with the patient or their legitimate representative. | mandatory |
| Person completing record | The details of the person who filled out the record. | mandatory |
| Senior reviewing clinician | The details of the senior clinician who reviewed the record. | mandatory |
| Contact for further information | Details of a contact who can provide further information. | mandatory |
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 the following example letters.
Further resources
- Standards explained
PRSB’s guide to standards which sets out the purpose and benefits of using standards and how to support frontline professionals to adopt them.
- IHRIM record correction guidance
Despite vigilance when filing information in records, mistakes can occur. The Institute of Health Records and Information Management has guidance to support professionals in making corrections following errors.
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