GPs call on hospitals to inform them when a patient dies

Doug Hendrie

11/01/2019 3:31:04 PM

West Australian GP Dr Amanda Villis hit a nerve when she recently called for hospitals to ensure GPs be informed when a patient had died while in hospital.

When a patient dies in hospital, their GP needs to know.
When a patient dies in hospital, their GP needs to know.

Dr Villis told newsGP that the lack of communication can lead to a number of issues.
‘Sometimes I’ll have a patient come in and I’ve got no idea their partner just died in hospital. It’s hard when you feel like you’re the last to know,’ she said.
Dr Villis said if GPs were kept informed, they would be able to bring in social supports for the deceased patient’s family and friends, or at least make contact.
‘Let’s say someone had rung me to say a patient had passed away. I might think, okay, the partner of that patient has mental health issues or a difficult social situation. So I’ll have to get them in, or try to get extra supports to them,’ she said.
Dr Villis has called for a standard approach across all hospitals, ensuring a patient’s regular GP is informed.
‘Best practice would be an automated fax or notification rather than waiting for the discharge summary, and then someone from the treating team calling the next business day,’ she said.
‘GPs are often not on the radar – we’re not in the hospital so they don’t see us. But, actually, we want to know.
‘We care a lot about our patients and know them well. This isn’t an afterthought. We’d appreciate a phone call to say, “Sorry this person has died, here’s what happened”.
‘Often hospitals don’t know about the social setting and the patient’s family. We are in a much better position to manage that.’
A common situation is when GPs first find out about the death of a patient through the hospital discharge summary. But these, as newsGP has previously reported, are very often late.
Dr Villis said the situation is exacerbated after a patient dies, as the priority drops.
‘They can take a month or longer,’ she said
Melbourne GP Dr Paul Grinzi responded to Dr Villis on Twitter, stating that there is ‘[n]othing worse than seeing a patient, asking how their partner (also a patient) is, only to find out the partner died during a recent admission you helped arrange.’
Dr Grinzi told newsGP the issue needs to be solved.
‘It’s really important – we need to be told of the outcomes after a hospital admission in a timely manner,’ he said.
‘It’s a professional courtesy. The name at the end of the [hospital] bed isn’t the whole healthcare team. The team are those who have been treating the patient – and the GP is a crucial part, both before and after the hospital admission.’
Many Australian hospitals already have notification systems in place intended to inform GPs if one of their usual patients dies in hospital. The Royal Perth Hospital, for example, has the GP Notify system designed to alert GPs to a patient’s admission, discharge or death.
But other hospitals lack such systems.
The call comes after Dr Kat McLean and her colleagues publicly lobbied for a change in terminology from ‘discharge summary’ to ‘clinical handover’, to stress the importance of good clinical communication between hospital doctors and GPs.
Dr McLean told newsGP that the issue is linked to the broader issue regarding discharge summaries and communication.
‘If we fixed the discharge summary problem it would go a huge way to fixing this,’ she said.
‘At the moment, discharge summaries can be delayed by weeks or months. So if you don’t receive [notification of a death] for months and you’re trying to recall the patient for an overdue Pap smear, for example, it has a domino effect.’

clinical handover communication continuity of care discharge summary hospitals

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Daniel Byrne   15/01/2019 7:49:29 AM

In southern Adelaide we have had an autofax notification system since the late 1990s from Flinders Medical Centre. I agree it needs to be a national system.

Daniel Byrne   15/01/2019 7:49:57 AM

In southern Adelaide we have had an autofax notification system since the late 1990s from Flinders Medical Centre. I agree it needs to be a national system.

Dr Elizabeth Lee Clark   15/01/2019 10:46:06 AM

Definitely we need to be notified.
If my patient dies at home I always notify the hospitals involved in their care to make sure they are not sent reminder letters for appointments also.

andrew hodson   15/01/2019 10:57:01 AM

No system of notification will ever be perfect or cover all circumstance. Get over it.
The vast majority of Australian hospitals now have automatic notification systems informing the PATIENT NOMINATED GP of their admission. How many of these nominated GP's then ring the hospital to give a clinical handover at the commencement of the admisssion? How many GPs check on progress during the admission? If we are so much wanting to be in the loop then our behaviour should be proactive rather than dumping on other parts of the system.

Kate   15/01/2019 1:52:52 PM

With respect Andrew, the death of a patient in hospital is a very significant event which is not normally the expected outcome of admission, and needs to be notified in a timely manner to the GP whether unexpected or not. I agree with your point that clinical handover does need to go in both directions, but an automated fax stating 'your patient has been admitted to ward 7C' often without any further detail hardly constitutes clinical handover either....

Christopher D Hogan   15/01/2019 3:05:43 PM

Longevity in Medicine has its positives but one of the downsides is the progressive loss of what used to be regular services & courtesies and increasingly poor interdisciplinary communication. The General Practice Prevocational Placement Program was extremely useful in rounding the medical education of junior doctors, of demonstrating the role & value of General Practice & showing how critical good interprofessional is.
However we have been treated to another example of governments incredible ability to snatch defeat from the jaws of victory & it was cancelled.
It is time to revive it.