MEDICAL MATTERS:Discharge papers from hospitals often lack crucial medical information, writes MUIRIS HOUSTON
MOST OF us, when we need hospital care, don’t feel particularly well. Being assertive is a long way from our priorities and abilities at such times of vulnerability. But from the point of view of our safety as patients, it may be something we (or our relatives) should prioritise. I came across three reports in the past week which prompted this column on patient safety.
A paper presented at the 25th annual meeting of the Irish College of General Practitioners looked at the quality of discharge information sent to GPs after a patient had spent time in hospital.
Dr Sean Bourke, a GP registrar in Ballinamore, Co Leitrim, analysed all discharge letters sent from the medical department of two local hospitals over a six-month period. Some letters were computer generated, while others were handwritten.
In terms of legibility, most of the letters written by hand by hospital staff were legible, although a small number were illegible. There are two items of major concern to a family doctor when reading a discharge letter.
The first is: what is the diagnosis on discharge? This was omitted in 21 per cent of computer- generated and 13 per cent of handwritten discharge summaries.
The other key item concerns drug treatment. Even though more than half the patients studied had a change in medication initiated while they were in hospital, the reason for starting a new drug was outlined in just 30 per cent of letters. This is not good news for patients.
Dr Bourke concluded: “This study shows that electronic records do not improve the overall quality of discharge summaries. The discharge letter must start at admission and vital information should be added during the patient’s admission and not just as the patient leaves the hospital. Discharge content is more important than delivery method and emphasis should be focused on improving standards and quality of the summary with regular audit to improve performance.”
The second piece of research, published in the journal Forum, looked at exactly the same issue but was carried out from a hospital perspective. David Prior, a registrar at the emergency department (ED) at Wexford General Hospital, looked at the quality of discharge letters written by ED doctors and sent to GPs. All patients who presented to the ED over a 24-hour period were included in the study.
Of 104 people who sought medical help during the 24- hour period, some 20 patients were admitted while others were dealt with in a way that did not require a discharge response. This left 72 case notes for analysis. A discharge letter had been sent for seven out of every 10 patients. But what happened to the other 30 per cent? The likelihood is they went to see their GP for follow- up in the following weeks resulting in the all-too-familiar scenario of doctor and patient trying to second guess the hospital doctor’s intentions. While doctors from individual specialities who had been called to assess the patients in the ED wrote letters of similar high quality to their ED colleagues – they listed a clear diagnosis in 90 per cent of cases – unfortunately they sent a communication in just 30 per cent of cases. Clearly this is not good for patient safety.
The Mental Health Commission published its annual report for 2008 last week. Within the Inspector of Mental Hospitals section of the report is an interesting analysis of medication prescribing for inpatient psychiatric units.
Of 1,556 individual prescriptions randomly selected, the name of the drug and dosage regime was easily identifiable in most. However, in the majority of prescriptions, the signature of the prescriber was illegible. Worryingly, in many cases it was impossible to tell when the drug was originally prescribed and so there was no way of knowing the length of time a patient had been on a particular medication.
Not surprisingly the inspector has recommended that the universally used card index system of prescribing on wards should be discontinued and that each signature on a prescription should have a corresponding printed name.
Three different reports with a single, unambiguous message: patients beware – Irish hospitals are not as safe as they might be.
Dr Houston is pleased to hear from readers at mhouston@irishtimes.com but regrets he is unable to reply to individual medical queries