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Improving discharge planning in NHS hospitals

Factors that need to be considered in discharge planning that have been identified in previous projects include:

  1. Ensuring that discharge arrangements are discussed with patients, family members and carers; and that they are given a copy of the discharge summary.
  2. Adequate coordination between the hospital, community health services, general practices, and the providers of social care services.
  3. There is a follow-up after discharge of patients at high risk of complications or readmission - either in person or by telephone - to ensure that the discharge arrangements are working well. 
  4. Medicines reconciliation is carried out. This is the process of verifying patient medication lists at a point-of-care transition, such as hospital discharge, to identify which medications have been added, discontinued, or changed from pre-admission medication lists.
  5. Ensuring that any outstanding test results at discharge are obtained and passed on to primary care teams; and ensuring there are clear arrangements for carrying out and acting on any proposed post-discharge tests. 

A useful summary of previous work on discharge planning (mainly based on US studies) can be viewed in UpToDate.

Another useful reference is a project carried out by the Department of Health, the RCGP and the RCP that aimed to produce a standardised electronic discharge summary that facilitated the care of patients after discharge from hospital. The project was carried out in collaboration with four NHS Trusts and gives a clear account of how to prepare a structured discharge summary, suitable for electronic transfer to GPs, and which contains the key information needed by primary care teams for the management of patients after discharge from hospital.

A summary of the project can be viewed at: http://systems.hscic.gov.uk/clinrecords/24hour

There is a more detailed presentation that can be downloaded at: http://systems.hscic.gov.uk/clinrecords/24hour/toolkit.pps - this is a 16MB PowerPoint presentation file.

You can view an example of the proposed discharge summary at: http://www.connectingforhealth.nhs.uk/systemsandservices/clinrecords/toolkit/materials/mockup/index.html

Of course, just having a template for a summary is not sufficient - the summary needs to be populated with accurate information and sent to practices in a timely manner. 

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