8COMPREHENSIVE GERIATRIC ASSESSMENT: IMPROVING COMMUNICATION BETWEEN THE ACUTE HOSPITAL AND THE COMMUNITY TEAMS CARING FOR FRAIL OLDER PATIENTS VIA THE USE OF A STRUCTURED DISCHARGE SUMMARY TEMPLATE

Abstract

Introduction: The North Middlesex University Hospital is a busy district general hospital with 100 Elderly Care inpatient beds. In the community, care home residents are supported by the community matrons and older patients requiring closer attention are monitored in Day Hospital. The Elderly Care Department received feedback that the available information at discharge was too non-specific and that this was preventing the provision of high quality continuous care outside of the hospital. The aim of the project was to address this by ensuring that core comprehensive geriatric assessment (CGA) domains were consistently handed over following an acute admission. Method(s): The Elderly Care Department identified 8 core domains to be clearly communicated in the discharge summary: summary of admission; cognition; nutrition; swallow; continence; skin integrity; mobility; social care needs; escalation of care. A discharge summary template was designed and implemented as the standard structure for all elderly care discharges in April 2018. Intervention(s): The discharge summary template was initially piloted on a single ward in March 2018. It was rolled out across the department from April 2018 and regularly reaudited to monitor compliance and identify issues. Amendments were made in June 2018 following input from speech therapy and palliative care. The consultants have championed the project and positively encouraged its use on their wards. At junior doctor changeover in August 2018, the discharge summary template was presented as a requirement at departmental induction. Result(s): Prior to the introduction of the template, baseline auditing of the quality of the department's discharge summaries showed that none of the discharge summaries consistently included information pertaining to the key CGA domains. By September 2018, the template was being used in 90% of discharge summaries indicating good compliance. The CGA domains were being included in 85% of the discharge summaries. Feedback from the community teams has been overwhelmingly positive. The junior doctors found using the template straightforward and not overly onerous. Conclusion(s): The implementation of the discharge summary template has vastly improved the quality of the information which is produced following an inpatient admission and has strengthened the collaboration between the inpatient and community teams. Future plans include introducing modified versions of the template for other hospital teams such as orthogeriatrics or stroke medicine.