When a GP spoke out over discharge summaries, it led to real change

In March this year, Dr Katrina McLean and two colleagues called for improved clinical handovers between hospitals and GPs.
 
Nine months later, and as more GPs called for urgent change, Dr McLean – who is also an Assistant Professor at Bond University – told newsGP that speaking out has led to direct improvements in communication with hospitals on the Gold Coast, where she works.
 
‘There is a long way to go but, locally, I feel we are in a much stronger position than we were 18 months ago,’ she said.
 
Dr McLean used her March article, published in MJA Insight, to illustrate the impact on GPs of poor-quality or late discharge summaries to the Chair of the Gold Coast Hospital and Health Service, who took the issue to the board.
 
The result? A commitment that local hospitals would work towards better communication with GPs.
 
‘At a local level, the Gold Coast HHS [Hospital and Health Service] is edging towards same-day discharge summaries. It is a work in progress, but I remain optimistic,’ Dr McLean said.
 
Gold Coast GPs have also progressed the issue by forming a clinical handover committee, with representatives from general practice, the Gold Coast Medical Association, primary health networks, and private hospitals.
 
The move comes after the Sunshine Coast Health and Hospital Service announced it would ensure discharge summaries are sent to GPs on the same day patients leave hospital.
 
Dr McLean said focusing on positives such as the Sunshine Coast example and offering concrete solutions has helped move the issue forward.
 
‘Providing solutions has assisted the push for positive change and improved patient care,’ she said.
 
Other GPs have also used the MJA Insight article to advocate for change, with a NSW GP recently writing to thank Dr McLean and her co-authors, using the article to point out the need for ‘safe, timely clinical handover of care into the community’.
 
‘[It is] not the first time I’ve asked for it, but the language matters, and having this article to refresh the “talking points” in my mind helps a lot. I think things might actually move forward – there was lots of goodwill,’ the GP wrote in their letter to Dr McLean.
 
Even with these wins, Dr McLean understands there is still a large task ahead, and change will require ‘considerable clinical leadership to shift the status quo’.
 
‘Clinical handover back to primary care … [is] unfortunately being perceived as less important than handovers occurring within or between hospitals,’ she said.

‘The hospital culture of a discharge summary being an administrative task undertaken by the most junior team member has not assisted, especially when junior doctors are grappling with high administrative burdens and unpaid overtime.’  
 
Like other GPs and experts who recently spoke to newsGP on the issue, Dr McLean does not believe uploading discharge summaries to a patient’s My Health Record is a substitute for a proper clinical handover.
 
‘There is a risk that the increased accessibility of hospital results by GPs may actually decrease the prioritisation of completing a clinical handover within the hospital setting,’ she said.
 
‘There would be some benefits in regards to accessing hospital discharge summaries via [My Health Record] from GPs who are not the nominated regular GP. One could argue, however, that this is not a handover, it’s throwing the information out there in the hope that a patient will prompt a GP to pick it up.’
 
Since June 2017, Queensland GPs have also had the ability to see patient data held in public hospitals in real time on the Viewer system. But Dr McLean has similar concerns about this system.
 
‘Unfortunately I have had the experience of being told “it’s on the Viewer” when phoning for clinical information relating to an acutely unwell patient who had recently been discharged from an acute psychiatric admission,’ she said.

‘This has the unintended consequence of posing safety risks to patients.’

clinical handover communication discharge summaries