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Report says hospital discharge must improve

Health inspectors in Wales say poor IT is stopping GPs getting right information

Mark Gould

Wednesday, 15 August 2018

Patients are being put at risk because of a lack of staff awareness about discharging them from hospital, a new report* concludes.

Poor relationships between GPs and hospitals also meant patients were staying in longer than necessary, it added.

The Healthcare Inspectorate Wales (HIW) report said "significant attention" was needed at hospitals. HIW called for more discussions between professionals and families about how and when discharge will take place, and said poor IT systems were stopping GPs getting enough relevant information.

Some places are making progress in the area of patient discharge, but the report found that progress "is far too variable" across Wales. Where inspectors saw increased usage of electronic discharge systems the quality and timeliness of information received by GPs was clearly improving.

The report concludes 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.

Key findings include:
  • 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.
Without a national approach for addressing delayed discharge health board policies were "fragmented", according to HIW's chief executive Dr Kate Chamberlain.

A doctor who works in Blaenau Gwent explained problems stemmed from transferring patients' large files between physical and electronic formats.

"The problem is transferring electronically between systems and there are still a couple of glitches there which mean large files can't be transferred properly," said Dr David Bailey, chairman of the BMA council for Wales.

"It is boring stuff but important for patients, especially patients who have these large files."

Health secretary Vaughan Gething had blamed difficulty in putting together a package to meet the patient's "complex needs", while the Welsh government said delayed transfer of care figures were at the lowest level for 12 years.

Dr Martin O'Donnell, RCGP Wales vice-chair, said patient discharge arrangements are a common source of frustration for patients, and they can be frustrating for GPs as well.

"When they leave hospitals, patients are not discharged from care, rather their care is transferred back to primary care. Good information sharing can ensure patients experience continuity of care even when they're seeing different healthcare professionals. When a patient leaves hospital GPs need to have the right type of information, particularly around medication and any significant developments during the stay. Often this isn't the case.

"Information also needs to be transferred in the right way; it shouldn't be a surprise that electronic discharge delivers improved outcomes. It's further evidence of the NHS being held back because of a lack of IT and technology.

"The report was also clear that communication between hospitals and general practice needed to improve."

*Patient Discharge from Hospital to General Practice:Thematic Report 2017-2018. A report prepared by Healthcare Inspectorate Wales, August 2018.

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