A discharge summary adapted to the frail elderly to ensure transfer of relevant information from the hospital to community settings: a model

Abstract

BackgroundElderly patients admitted to Geriatric Assessment Units (GAU) typically have complex health problems that require multi-professional care. Considering the scope of human and technological resources solicited during hospitalization, as well as the many risks and discomforts incurred by the patient, it is important to ensure the communication of pertinent information for quality follow-up care in the community setting. Conventional discharge summaries do not adequately incorporate the elements specific to an aging clientele.ObjectiveTo develop a discharge summary adapted to the frail elderly patient (D-SAFE) in order to communicate relevant information from hospital to community services.MethodsThe items to be included in the D-SAFE have been determined by means of a modified Delphi method through consultation with clinical experts from GAUs (11 physicians and 5 pharmacists) and the community (10 physicians and 5 pharmacists). The consensus analysis and the level of agreement among the experts were reached using a modified version of the RAND®/University of California at Los Angeles appropriateness method.ResultsA consensus was reached after two rounds of consultation for all the items evaluated, where none was judged «inappropriate». Among the items proposed, four were judged to be « uncertain » and were eliminated from the final D-SAFE, which was divided into two sections: the medical discharge summary (22 main items) and the discharge prescription (14 main items).ConclusionsThe D-SAFE was developed as a more comprehensive tool specifically designed for GAU inpatients. Additional research to validate its acceptability and practical impact on the continuity of care is needed before it can be recommended for use on a broader scale.

Optimizing the quality of hospital discharge summaries – a systematic review and practical tools

“…Similarly, the Australian Melbourne Children's Hospital recommendations contain helpful practical content, including a checklist, to be used in training [66]. By following the sections of a checklist step by step (for an example, see Table 2), the content and structural aspects can be incorporated and a standardized form of reporting can be obtained, errors in the content of the DS can be reduced, and its quality can be improved [39,67,68].…”

Evaluation of deficiencies in current discharge summaries for dialysis patients in Canada

“…In an attempt to standardize the transmission of complete and relevant hospitalization information, the Joint Commission on the Accreditation of Healthcare Organizations in the USA established standards outlining the components that each hospital discharge summary should contain 9. Although this has led to improved communication and a reduction in adverse events after discharge, the “one size fits all” approach to discharge summary creation may be problematic and incomplete for the more fragile and vulnerable health care populations 10. One such population is those with end-stage renal disease on dialysis.…”

Quality-of-Care Processes in Geriatric Assessment Units: Principles, Practice, and Outcomes

“…The Discharge Summary Evaluation Tool was the basis for the Discharge Summary Adapted to the Frail Elderly patient, which was recently published. 27 Assessment was independently carried out by two geriatricians and one public health physician after a reiterative validation process on 20 discharge summaries. The total of points was determined and expressed as a percentage.…”