Overview
Hey guys! Welcome back to another Wednesday banger!
This week’s article is aimed at how to write an effective (and concise) discharge summary!
This article will cover the following topics:
Introduction
I do not miss discharge summaries.
They’re boring, time consuming, use clunky outdated medical software and most of the time involve a patient I’ve never even seen.
There’s also usually a backlog of hundreds of them, which mean that no matter how many I manage to complete, there will always be more. You can imagine what a fantastic morale booster this is amongst an already tired and exhausted junior doctor workforce.
They were the bane of my existence as a junior doctor. Amongst all the administrative tasks I did in a day as an intern or resident, completing discharge summaries was on the bottom of the list. This was mainly because there were so many other, seemingly more important tasks that I was required to do to fulfil my role.
For example, as an intern, if I ever told anyone that the cannula in Bed 27 can wait until I finish this important discharge summary, I would have been eaten alive. That’s just the way tasks are prioritized in the hospital.
Now as a GP registrar, I can see the other side of the story. GP’s rely on discharge summaries to explain what happens when their patient enters the black box of the hospital system. Without them GP’s are left floundering in the dark and have to channel their inner Sherlock Holmes to piece through the broken information from the patient.
Patients are often discharged from hospitals with the blanket instruction to ‘follow up with their GP’. Now whilst this is considered safe practice, when the patient rocks up at my door sans documentation requesting X, Y, Z, I find myself in a bit of a pickle.
So today, I thought I would run through a few quick tips on how to write an effective and concise discharge summary as a junior doctor. I’ve written this list to make it as time efficient for a junior doctor to pump out a discharge summary whilst still relaying all the relevant information to your GP colleagues.
Tip #1: Know Your Audience
Every junior doctor will write a discharge summary in their clinical career (if you don’t, please tell me where you have been working so I can apply too). So it’s important to know who you are writing this discharge summary for and why you are writing it.
Imagine you are a GP. You have 15 minutes to follow up with a patient who was discharged from hospital 2 days ago. You have 30 seconds to glance at their discharge summary before calling them into the room. What information would you like to see in those 30 seconds that would make the next 15 minutes go smoothly?
The answer is below:
Tip #2: Keep It Simple
Follow the Keep It Simple Stupid (KISS) Principle when it comes to writing discharge summaries.
Identify key issues: What are the 3-4 (or sometimes more) most important issues from the patient’s admission. Is it their hyponatremia that needs to be monitored? Or is it their declining exercise capacity? Or is it an exacerbation of heart failure? Or worsening cognition? Try and distill the ‘problems list’ into the discharge summary.
Briefly summarise the interventions: Did the person receive IV frusemide? Did the person receive a geriatric assessment for newly-diagnosed dementia? Did they have a surgery to remove a cancer?
Attach relevant investigations: We don’t need every single FBC ever ordered during an admission. One on admission and one of discharge is sufficient. Attach imaging investigations which have pertinent positive or negative findings. Attach histopathology from any tumours or masses removed.
Let us know what follow up has been arranged: Will they be seen in the outpatient department in 4 weeks time? Will they receive a phone call from the department post-operatively?
Tip #3: Keep It Concise
Use dot points or numbered lists. Unfortunately GP’s are just as time poor as junior doctors and don’t have time to read paragraph’s of well-written medical prose. We just need the bare bones of the medical admission so that we can cast our eyes over it briefly and understand what happened in hospital. Aim for 1 page (or less) summary of what happened.
Tip #4: Time Matters
Time. Matters.
A mediocre yet timely discharge summary is FAR BETTER than a perfect yet 3-month late discharge summary. When a patient is discharged, they will see their GP within a week. Ideally, the GP wants to receive correspondence within this time frame.
This is such a hard time frame for junior doctors to stick to. They are already swamped with bucket loads of other administrative tasks, that asking them to keep on top of discharge summaries is as likely as watching pigs fly.
So for any junior doctor out there who is reading this, if you have something that you would like the GP to urgently do but don’t think you’ll be able to get a discharge summary out to them in time, just give them a call. Quickly google their name, punch in the practice phone number and kindly hand over to the GP. They will love you for it!
Remember, GP’s were once junior doctors too (although some in the far far distant past). Most of the them understand the struggles of the hospital system and being the lowest rung on the ladder. They will appreciate the time and effort you’ve put in to perform the clinical handover.
From experience, hospital departments often have a backlog list of hundred’s of pending discharge summaries from 3-6 months ago. I am very skeptical as to whether completing a discharge summary from 6 months ago adds any value to a patient’s continuity of care but hospitals will tell you that it needs to be done to meet KPIs (sigh).
Tip #5: Give Clear Instructions
As a junior doctor, what specific things would you like the patient’s GP to do?
It could be re-examining their abdomen after surgery or re-prescribing a certain medication or checking their thyroid function. Whatever it is, make it clear that you would like us to follow it up.
The one caveat to this is the classic “GP to chase” line that get’s sprayed all over discharge summaries. This is usually in relation to tests that are still pending once a patient is discharged from hospital.
If you would like us to “chase” a result, we need to have access to said result. This was something I didn’t understand as a junior doctor (being honest here) and I think it reflects a systematic issue with the way tests are ordered in hospital. I was never shown and I’m not sure how many of my colleagues knew either. There is probably some function deep within the electronic medical record that let’s a person do this, but I was not aware of it. If anyone reading this does know, please enlighten us all and leave a comment down below.
This makes it hard for GP’s, who, unfortunately, do not have access to a hospitals electronic medical record system. It also takes a significant amount of time to call the hospital pathology and ask about the result. Once again, I don’t think junior doctors are to blame here because, like I said, its a systematic issue.
Final Thoughts
Discharge summaries are not fun. No one enjoys them. However, hopefully the 5 tips in this article will help all those amazing junior doctors out there smash out some discharge summaries and continue clinical care for their patients. And on behalf of all GP’s who do receive amazing discharge summaries from hospitals, a big thank you to the junior doctors!! We see you and appreciate your hard work!
For any GP’s out there who received my questionable (nay horrendous) discharge summaries as a junior doctor, please consider this my retrospective apology.
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