New one-page discharge summary for patients to be trialled

Doug Hendrie

24/04/2019 1:50:10 PM

Many patients find being discharged from hospital deeply confusing. Can a new patient letter address the issue?

Patient leaving hospital
Leaving hospital can be confusing. Can this initiative help?

Once discharged from hospital, many patients are understandably bewildered about exactly what just happened.
They might receive a medication list and a pamphlet about their condition. Their GP will receive a discharge summary.
But for those patients who want to be actively involved in their own medical care and recovery, the medical jargon and fragmented communication can be a major barrier. Not only that, but a lack of knowledge can lead to patients failing to properly manage their medical issues, potentially leading to readmissions.
It is for that reason that Professor Geoffrey Tofler, a cardiologist at Sydney’s North Shore Private Hospital, is trialling a one-page patient directed discharge letter (PADDLE) aimed squarely at improving how much patients understand about their hospital stay.
‘We want the patient to get this letter prior to discharge, given to them by hand and discussed with them. It would come with the medication list and the GP discharge summary,’ he told newsGP.
‘There’s evidence that if people are confused and don’t have a good understanding of what happened in hospital and don’t have a good idea what to do at home, it can have adverse outcomes like not following instructions or being readmitted to hospitals.
‘When you see patients in hospital, there’s a lot going on. I’d like to think I explain what happened in detail, but we know that patients forget things.
‘It’s the same when I take my car to the mechanic – he explains what happened, I nod as if I understand, but I may not.
‘A lot of the words [doctors] use, we think they’re well known. But usually, in fact, it’s not so clear and the patient may hear something different.’
Professor Tofler said there is an increasing focus on patient knowledge and control of the medical process.
‘Discharge summaries are written for GPs, and so often the language used is not at the level of the patients. We felt that was a gap we could help with,’ he said.
‘I’d like to think that every patient would benefit from a PADDLE [letter].’

Professor Geoffrey Tofler believes that while many doctors may think language they use on discharge summaries is well known, it is likely unclear for patients. 

The three-hospital trial received $200,000 in funding from the HCF Research Foundation to refine the letter and test whether it reduces readmissions and adverse events.
The move comes after Professor Tofler’s team ran a pilot study in 2014, finding that a one-page letter to patients did indeed aid their understanding of what had happened and what they should do to manage their condition.
A key issue that emerged from that trial was the challenge of how to get these letters written in a timely and accurate fashion. There has also been a widespread push, as evidenced by recent newsGP reports,  by GPs to reframe discharge summaries as clinical handovers.
‘With busy residents and time pressures, it’s difficult to fit it in. That was the challenge, how to fit this in in terms of timing, given it’s an extra time component,’ Professor Tofler said.
To help time-poor hospital residents – who tend to be given the task of writing discharge summaries – Professor Tofler and his team have experimented with automating the letter production as much as possible by producing templates for common conditions, using layperson terminology proven to be understandable.
A letter for a heart attack is a one example:
‘You came in with chest pains, short of breath and sweaty. Your ECG showed changes suggesting a heart attack and this was confirmed by a troponin blood test … You’ve been started on two medications and a cholesterol lowering tablet. The nurse has given you a pamphlet to look at and arranged rehabilitation classes. When you are back home, take the medications on your medication list. Don’t drive for two weeks and avoid heavy exercise for six weeks. Your follow up appointments with your GP are listed. If you have any concerns or questions, speak to your GP.’
Professor Tofler hopes the trial will show that the PADDLE letter is both feasible and useful, and will lead to widespread adoption of a patient discharge letter produced alongside the GP discharge summary.
‘We will encourage patients to show it to their family, and we’d be happy if they showed it to their GP as well,’ he said.

discharge summaries hospital admissions patient directed care

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Dr Charlene Fungai Chideme   25/04/2019 9:05:36 AM

What a brilliant initiative! Thank you.

Dr Ming Chien Li   25/04/2019 10:22:55 AM

good idea

Dr Ming Chien Li   25/04/2019 10:23:59 AM

very good idea

Ian Truscott   25/04/2019 10:25:20 AM

Yes. Also, a quick phone call to GP during the admission helps, even at the start! Often, info is gained by both hospital Dr & GP!
I cringe at most discharge summaries, in which one searches for 2 or 3 lines of USEFUL info, amongst 14 pages of it.

Alyson   25/04/2019 1:43:40 PM

This sounds like a great initiative and will be helpful also for the times a discharge summary is in fact not received by the GP or not in a timely fashion. Having to go through medical records to access a discharge summary is a very time consuming process

Dr Silloo Ardeshir Mahernosh   25/04/2019 3:05:28 PM

One page discharge summary is a very good idea. It is well worded that any non medical person can understand without medical mumbo jumbo.
If they have any problem they can contact us.
Thank you very much.

Robyn   25/04/2019 3:12:53 PM

Hi great idea. I am just going to point out the obvious. $200000 to write a letter? I have many uses for $200000 at my small country hospitals and relearning how to write a letter is not on the list.

Lindsay   25/04/2019 5:49:08 PM

" It would come with the medication list and the GP discharge summary".
Ah, yes: I do remember discharge summaries, in the distant past. I used to write them myself, & they were handed to the patient before they left hospital. Now, I consider myself lucky to receive any info from our local hospital, or it arrives several weeks after the patient has seen me post-discharge. And don't mention the 'wonderful ' MyHealthRecord, or my (in)ability to access info from the Qld Health Viewer...maybe we should focus on getting the fundamentals right, don't you think?

Sue McDonald   25/04/2019 6:53:37 PM

My thoughts exactly, Robyn. One doesn't have to reinvent the wheel! It's common sense. We could do masses with that money in GP land.
Oschner Medical School in New Orleans is miles ahead of all of this. They have completely reorganised their hospitals around the patients experience and GP's with hugely successful outcomes. It's a win win for everybody.
Unfortunately Australia is still in the dark ages frozen by bureaucracy that is not evidence based, and woeful IT designed for IT nerds not clinicians.

Kat McLean   26/04/2019 7:03:13 AM

I'm all for improving communication as patients transition back to primary care. A clinical handover to the GP needs to occur at the point of transition and patients educated as to what has transpired and what the ongoing plans are. I'd suggest that rather than creating another document (that may or may not reach the GP) that the info is incompleted in the specific 'info to patients section'. I'm a little concerned that in an attempt to improve communication this actually complicates things?

Could we no just place and enforce standards around clinical handover to primary care and allow time pressed residents time to speak with and educate patients? After all it's what we train them to do in medical school.

Paul Neeskens   26/04/2019 7:36:36 AM

I disagree that discharge summaries are written for the GP.
At least in QLD the the Enterprise Discharge Summary ( EDS) is more about creating a record of events for data capture by the System.
Quality clinical handover, Doctor to Doctor , is not a discharge summary. Its a letter written by a Doctor to another Doctor - concise, precise in proper english with enough information for the receiving Doctor to efficiently and effectively continue the care. This requires 2 things - Will and Skill.

Yes lets have a letter to the patient.
Yes let have EDS to capture data sets.
But bring back the Discharge Letter - Doctor to Doctor - using proper sentences and good English. Good Doctors do this well, without whingeing about being too busy.

Dr Viviane S Leventhal   27/04/2019 1:54:22 AM


4thwatch   27/04/2019 8:26:11 PM

Great initiative to a very real communication problem. Hospital- GP communication has sadly been an issue for decades. While this letter may not solve the problem entirely, it will at least assist the patient in understanding appropriate follow up instructions up until he/ she can see his or her GP.
It is encouraging to know that clinicians are interested in improving this communication.
It is sad to note the criticism from presumably (?)health colleagues above . Unfortunately this perpetuates the very old “ Australian tall poppy syndrome”.
If funds are needed elsewhere- eg smaller hospitals that perhaps proposals should be put forward and appropriate grants sought.
It would be good if the health profession stood united and encouraging on whatever improvements are made- be they small or large.