Quality of discharge information impacting on patient care

The way in which patients are discharged from hospital is critical to the effectiveness of their ongoing care in the community. The quality and timeliness of discharge information provided by hospitals is of particular importance and formed the focus of the HIW review. 

Overall, we found the quality and timeliness of discharge information was variable across Wales, with this area of the NHS requiring significant attention to ensure that safe and effective healthcare is provided. 

It is clear that some parts of the NHS in Wales are making progress in the area of patient discharge but progress is far too variable across Wales. Where we saw increased usage of electronic discharge systems the quality and timeliness of information received by GPs was clearly improving. 

We found that all health boards had appropriate policies in relation to discharge. However, there appears to be a lack of awareness and understanding of these processes from staff on some wards and this lack of clarity, combined with poor IT infrastructure and a failure amongst professionals to take responsibility for effective communication can put patients at risk. 

The key findings from our review are:

• Electronic discharge (e-discharge) has had a positive impact on both quality of information and timeliness of receipt by GPs 
• Discharge is often more efficient where ward-based pharmacy staff are used
• Professionals involved in patient care need to take greater responsibility for ensuring that they provide timely, accurate and relevant information to colleagues in order to achieve continuity of care
• There is a need for greater clarity around the roles and responsibilities of those healthcare professionals involved in the discharge process, with stronger relationships needed between GPs and hospitals
• There is often insufficient engagement with patients and families on how and when discharge will occur

We have made 13 recommendations for NHS Wales healthcare organisations and NHS Wales to consider as result of these findings.  

Chief Executive, Dr Kate Chamberlain said:

Our review recognises the commitment of staff to improve management of patient discharge, with some examples seen of good practice being developed across Wales. However, the overall picture is variable with a fragmented approach being taken across Wales and local initiatives and tools being developed in the absence of national solutions being implemented. 

Poor discharge can lead to poor ongoing care for patients in the community. Addressing this requires each professional involved in a patient’s care to take responsibility for their part in effective discharge.