Acute coronary syndrome discharge summary audit: a quality improvement initiative

Abstract Introduction The discharge summary is the cornerstone of communication between cardiologists and general practitioners, ensuring a safe transition from hospital to home following acute coronary syndrome (ACS) treatment. The European Society of Cardiology (ESC) recommends a structured discharge proforma consisting of eight essential components: medical history, reason for admission, management, investigations, main laboratory results, discharge prescriptions, follow-up instructions and therapeutic targets, with an emphasis on lipid-lowering goals and the duration of dual anti-platelet therapy (DAPT). Objective This study aims to enhance patient care quality by evaluating the completeness of post-ACS discharge summaries at our tertiary cardiology centre against ESC consensus guidelines to pinpoint commonly omitted information. Methodology A retrospective audit was conducted on 205 ACS discharge summaries between January and December 2024, utilising the ESC template for reference. SPSS was used for data analysis. Results 30 cases were excluded due to missing documents. The results are summarised in Figure 1. Our findings reveal that over 80% of summaries adequately reported essential clinical details such as the reason for admission, primary diagnosis, culprit lesion, coronary angiogram procedures, statin and antiplatelet dosages. More than 60% documented DAPT duration, outpatient follow-ups, beta-blockers, proton pump inhibitors, cardiac rehabilitation appointments, key angioplasty results, symptom onset and echocardiogram results including left ventricular function. However, 40-60% included renin-angiotensin-aldosterone system inhibitors, ECG changes, peak troponin levels, cardiovascular risk factors, regional wall motion abnormalities and relevant secondary diagnoses. Critically, less than 30% addressed necessary lifestyle modifications, renal function, LDL targets and relevant additional tests. Under 20% mentioned diabetic medications, further revascularization plans, driving restrictions, HbA1C, and cholesterol levels. Notably, HbA1C target was only mentioned in two diabetics. Conclusion The audit highlights a significant gap in the quality of discharge summaries, underscoring the need for enhanced training and supervision of junior doctors, particularly under the constraints of time pressure which may lead to incomplete documentation. The introduction of a first-in-Ireland virtual PCI pathway at our institution promises improvement, providing physicians additional time post-discharge to complete summaries thoroughly, supported by a dedicated nursing staff to ensure accuracy. To further this goal, we have implemented a checklist poster in the cardiology office (Figure 2) and initiated monthly training sessions on discharge summary preparation. A re-audit is scheduled to assess progress and emphasise the critical role of high-quality discharge summaries in minimizing rehospitalisation and ensuring coordinated care in the community.Key clinical details captured Discharge summary guidance template