6497 Have you written the discharge summary?: A Qip to tacjle the backlog of discharge summaries

Objectives Discharge summaries are an essential communication tool with the wider multidisciplinary team responsible for the holistic care of the child: GP, social services, CAMHS and tertiary specialist teams. The summary provides important information on the events that led to an attendance or hospital admission, and possible amendment to their care such as new medications and planned follow-up. As per NHS Standard Contract, all patients discharged from hospital after acute management must have a discharge summary sent to their GP within 24 hours.1 This includes the Paediatric Assessment Unit. However, this was a problem a few years back for the trust. In 2019, a CQC inspection showed that over 300 paediatric discharge summaries had not been completed. This then became a CQC 'must do' for the trust. The objective of this quality improvement project was to complete discharge summaries within 24 hours of discharge from the hospital. Methods Various solutions were used to tackle the backlog. These include: Induction for new doctors included the importance and practicalities of writing a discharge summary Locum shifts to FY1s to complete discharge summaries Physically handing over outstanding summaries to clinical teams for the day to be completed Involving other specialties to complete their discharge summaries Completing discharge summaries on the same electronic system patients are admitted on The use of a ward clerk, who constantly checks for outstanding discharge summaries and informs the senior leadership team about them, using a spreadsheet. Subsequently, the ward clerks keep a daily spreadsheet with the number of outstanding summaries and disseminate it to senior service managers of the medical and nursing teams to ensure oversight and prevent accumulation. Results The most significant change came with the use of locum FY1s to clear the backlog; however, this was not cost-effective. A proactive ward clerk who asks doctors to complete discharge summaries when patients are discharged and also gives them any outstanding ones to complete was the most economical tool to deal with this problem. Furthermore, low paediatric activity during the COVID-19 pandemic helped clear most of them. However, this crept up again when the unit returned to normalcy. Our current discharge summaries stand at zero for general paediatrics. Conclusion Discharge summaries are essential for all children seen in the hospital and this is occasionally forgotten due to clinical pressures. Using the multi-disciplinary team including ward clerks can prevent the accumulation of a backlog and ensure summaries are completed at discharge or within 24 hours after discharge. Reference 'NHS Standard Contract 2023/24 Service Conditions (Full Length)' 2023. NHS England.