Improving the quality of heart failure discharge summaries

Abstract

A discharge summary is intended to communicate relevant clinical information to GPS after hospital admission. High-quality discharge summaries are especially important in complex clinical syndromes, such as chronic heart failure, where effective communication between multi-disciplinary teams is necessary to coordinate safe community care and reduce rehospitalisation risk. The aim of this study was to audit the existing quality of heart failure discharge summary documentation at our Trust and test whether a 10-point checklist poster could improve performance. All heart failure discharge summaries issued from Barking, Havering and Redbridge University Hospitals' NHS Trust over a three-month period were assessed. The content of each heart-failure-verified discharge summary was objectively analysed using a points-based scoring technique. A single checklist poster providing guidance on composing heart failure discharge summaries was positioned in a medical ward. The scores from every summary issued by doctors exposed to the checklist poster (n=24) on that ward were compared against discharge summaries scores issued by doctors working on all other (non-exposed) wards (n=84). Of discharge summaries with heart failure listed as a primary diagnosis, 28% were found to have an alternate cause for symptoms and no verifiable evidence to support a heart failure diagnosis. Discharge summaries issued by doctors working on the ward exposed to the checklist poster had a mean discharge summary score of 5.2 ± 0.59. Discharge summaries issued by doctors working on wards that were not exposed to the checklist poster had a mean score that was significantly poorer 1.7 ± 0.11 (p<0.001). This study demonstrates that a primary heart failure diagnosis may be inaccurate in approximately a quarter of all discharge summaries. The provision of a 10-point checklist was associated with a statistically significant improvement in the quality of heart failure discharge summaries issued from our Trust. This intervention was simple to implement at minimal cost and helps junior doctors communicate more effectively with primary care.