A Clinical Audit and Quality Improvement Project Assessing Discharge Summaries from Infectious Diseases and Medicine for the Older Person Services

Abstract Background Discharge summaries are the chief method of communication between hospital and community. They provide a repository for future hospital staff in the event of re-presentation. Absent or inadequate discharge summaries can have wider implications for patient safety, quality and cost of care. The aims of the project are as follows: Methods Retrospective data was collected from 20 randomly selected e-discharge summaries completed by each specialty over 3 months (n=40). These summaries were assessed against the Health Information and Quality Authority’s National Standard for Discharge Summaries. Data was recorded on an anonymised Microsoft Excel sheet and analysed using SPSS Statistics. Results The average time between discharge and completion of discharge summary was 0.75 days for MFTOP and 14.4 days for ID. When compared against the National Standard, MFTOP produced 7 “ideal” summaries and ID composed 0 (p=0.0083). To break this down, 16 MFTOP summaries included the complete clinical course, while 12 ID summaries included this (p=0.3008). 9 MFTOP and 1 ID summary included a complete discharge prescription (p=0.0084). MFTOP accurately documented follow-up plans in all 20 summaries. 2 ID summaries did not include follow-up plans (p=0.4872). Conclusion This audit highlights the disparity between current and desired standards for discharge summaries. Barriers to improving the quality of summaries include inadequate staffing, discharges on short notice, high staff turnover and unclear documentation. Interventions we propose include: