Safety issues in post-discharge care of older patients in general practice: an ethnographic study

BACKGROUND: Post-inpatient discharge is a risky time for older patients, especially those with polypharmacy and multimorbidity. General practice care at this time, including the processes for managing hospital discharge summaries, lacks standardisation and is of variable quality. Understanding these processes will support the design of interventions and guidance to improve general practice management of the post-discharge period. AIM: To understand and visualise how ongoing care for older people after discharge from hospital is organised in general practice, including the processes for managing discharge summaries. DESIGN AND SETTING: Rapid ethnography study in 10 general practices in the West Midlands, England. METHOD: We mapped the practices' systems of post-discharge care. Data sources included informal conversations with staff, practice policies, and direct observations of discharge summary handling. Fieldnotes and quotes were subject to an interpretivist framework analysis. A systems modelling technique (the Functional Resonance Analysis Method) was used to present visual representations of the professional roles working in these complex systems. RESULTS: Three basic typographies of system emerged based on professional roles: GP-led, pharmacist-led, and administrative-led. We report on three themes that weave around the Functional Resonance Analysis Method process maps: comfort with demands of administrative role; general practice team dynamics; and interaction with patients. CONCLUSION: General practice systems for inpatient discharge summary processing are complex and varied. New roles in general practices are being used extensively, often requiring significant input in supervision by GPs. Our findings highlight safety features of different systems and should help practices understand the advantages and limitations of models they work within.