Experience of medical senior house officers in preparing discharge summaries
BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7027.350 (Published 10 February 1996) Cite this as: BMJ 1996;312:350
- J P Frain, senior house officera,
- A E Frain, trainee general practitionerb,
- P H Carr, consultant physiciana
- a Department of Medicine, Darlington Memorial Hospital, Darlington DL3 6HX
- b Netherlaw Surgery, 28 Stanhope Road, Darlington
- Correspondence to: Dr Carr.
- Accepted 5 December 1995
The discharge summary communicates information about a patient's stay in hospital and follows the hand written summary that accompanies the patient on discharge. Previous studies have indicated dissatis-faction among general practitioners with the quality of discharge summaries.1 2 Most are done by senior house officers, and this survey assesses their experience in preparing them.
Subjects, methods, and results
A medical senior house officer from each of 100 acute hospitals in England replied to a telephoned questionnaire about teaching they had received on preparing discharge summaries and arrangements for doing summaries in their hospital.
Ninety two of the doctors prepared summaries in their present post. On six firms the house physician was responsible, while a consultant and registrar were responsible in the other two. Six senior house officers, all from overseas medical schools, had received teaching as undergraduates. Nineteen had received teaching in their present post, usually from their consultant; but most learnt by osmosis. Twenty eight doctors had been given written guidelines, but only 14 thought they were helpful.
Fifty seven of the doctors had to produce the summaries within a set period after discharge, the deadline ranging from the same day to two months, with a mode of two weeks. Thirty one doctors were able to complete all their summaries within the working day; 45 had to do their summaries completely outside the hours of 9 to 5, either when on call or in their own time. Twenty doctors were doing all their summaries outside their contracted hours and a further 38 at least some of their summaries outside contracted hours.
Once completed the summaries were vetted by the consultant in 13 cases regularly and in five occasionally. Eighty six doctors had never received formal feedback on the quality of their summaries. Table 1 shows who was responsible for the summaries when the senior house officer was on leave.
Person responsible for preparation of discharge summaries during absence of the usual doctor responsible
Comment
The subject of discharge summaries aroused strong feelings among the doctors questioned. The most notable finding of our survey was the lack of guidance given to doctors in preparing summaries. There seems to be an assumption that without training every doctor can write a good discharge letter. This lack of guidance together with other more immediately important commitments may lead to discharge summaries being given a low priority so that quality is suboptimal and there is little opportunity for formal feedback.
Few doctors were always able to meet their deadlines, and only 6% met them even “usually.” Many suggested that time should be specifically set aside and included in senior house officers' contracts since an average of 20 discharge summaries a week may take four hours to write. This has further significance if the summaries are done by a consultant in the senior house officer's absence.
Medical students spend much time learning to take a good history and perform a physical examination. This should be developed to include training in keeping case notes, presentation skills, and writing clinic letters and discharge summaries. At postgraduate level the preparation of a discharge summary could form part of an audit of a firm's admissions over the previous two weeks. This would ensure both the quality of the summary before it was posted and that all “loose ends” had been dealt with before the next outpatient appointment.
The challenge is to design a summary simple to produce, tailored to the individual patient, informative for the general practitioner and future doctors in contact with the patient, and educationally beneficial to the senior house officer. Solutions are best developed locally with junior doctors, consultants, and local general practitioners all being involved.3
Footnotes
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Funding None.
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Conflict of interest None.