GP perspectives on hospital discharge letters: an interview and focus group study

Abstract

Background Written discharge communication following inpatient or outpatient clinic discharge is essential for communicating information to the GP, but GPs’ opinions on discharge communication are seldom sought. Patients are sometimes copied into this communication, but the reasons for this variation, and the resultant effects, remain unclear.AimTo explore GP perspectives on how discharge letters can be improved in order to enhance patient outcomes.Design & settingThe study used narrative interviews with 26 GPs from 13 GP practices within the West Midlands, England.MethodInterviews were transcribed and data were analysed using corpus linguistics (CL) techniques.ResultsElements pivotal to a successful letter were: diagnosis, appropriate follow-up plan, medication changes and reasons, clinical summary, investigations and/or procedures and outcomes, and what information has been given to the patient. GPs supported patients receiving discharge letters and expounded a number of benefits of this practice; for example, increased patient autonomy. Nevertheless, GPs felt that if patients are to receive direct discharge letter copies, modifications such as use of lay language and avoidance of acronyms may be required to increase patient understanding.ConclusionGPs reported that discharge letters frequently lacked content items they assessed to be important; GPs highlighted that this can have subsequent ramifications on resources and patient experiences. Templates should be devised that put discharge letter elements assessed to be important by GPs to the forefront. Future research needs to consider other perspectives on letter content, particularly those of patients.

What makes a “successful” or “unsuccessful” discharge letter? Hospital clinician and General Practitioner assessments of the quality of discharge letters

“…The Discharge Communication Study [27] (of which this research is a part) investigated ways of improving the content and processes surrounding discharge letters. Results relating to GP interviews contextualising elements of successful letters [28], and patient interviews (which investigate patient-provider communication) [29] have already been published elsewhere. In this paper we report clinicians' opinions on the quality of discharge letters which are crucial to understanding how to improve inter-professional communication at the time of discharge.…”

Implementation of a complex intervention to improve hospital discharge: process evaluation of a cluster randomised controlled trial

“…For instance, several studies from different countries reported that GPs appreciated receiving information on medication changes and reasons in the discharge letter. [33][34][35][36] Our findings show that GPs perceived this as more convenient than having to actively call the-often unavailable or difficult to contact-HPs. Therefore, and not too surprisingly so, the number of GPs contacting HPs after their patients' discharge was low.…”

Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients’ subsequent clinical course and outcomes

“…12 There are also no clear standards for the content, format and manner of feedback delivery appropriate for specific clinical settings, thus feedback may be less effective. 18…”