Intensive care discharges: improving the quality of clinical handover through changes to discharge documentation

Abstract

Patients who have stepped down from intensive care tread a precarious clinical course, and the handover of care between clinical teams at this point should be treated as a high risk event. Poor handover can leave patients vulnerable to suboptimal care and preventable harm. Properly structured written discharge summaries have been shown to improve information transfer and quality of care. The National Institute for Health and Care Excellence (NICE) has published guidelines entitled “Acute illness in adults in hospital: recognising and responding to deterioration,” which states that patients transferred from intensive care should have a formal structured handover supported by a written plan, and it provides minimum criteria for what information should be included. A retrospective audit was carried out (n=28) to identify if discharge summaries were compliant with these standards. Discharge summaries consistently lacked essential criteria, including psychosocial needs (29%), nutritional needs (50%), therapy needs (29%), ceilings of care (39%), and communication needs (18%). Less than a third of verbal handovers between the nursing and medical teams were documented. After consultation, a new summary template was developed and embedded into practice. The new design prompted trainees to ensure they completed adequate information in all domains of care. Additional sections were added to improve recording of when, and to whom, clinical handover took place, which led to improved clinical governance. The overall quality of discharge summaries was improved, with increased compliance in 11 out of 13 domains. Feedback from staff about the new discharge summaries was positive. This project is easily transferable, and has the potential to improve patient safety and quality of care.

Assessment of the nursing care product (APROCENF): a reliability and construct validity study

“…On the other hand, the items with negative weights, adding up regular and poor, are related to Interaction and multidisciplinary activity (59.9%) and Care monitoring and transfer (28.5%). These questions seem to advance timidly in view of the complexity of the interventions and the need for knowledge articulation and team integration 23 .Therefore, teaching and interdisciplinary practice have been investigated, and are currently encouraged to improve the fragmented health systems, constituting a feasible and efficient service provision model 24 .Another challenge evidenced in this study that is in accordance with other findings 25 is related to the transfer of information among clinical teams through formal registers, reducing adverse incidents and improving the continuity of health care.…”

Defining Minimum Necessary Communication During Care Transitions for Patients on Antihyperglycemic Medication: Consensus of the Care Transitions Task Force of the IPRO Hypoglycemia Coalition

“…Few studies have examined the role of structured discharge summaries for patients with high-risk medical conditions such as diabetes [17,31]. In addition, studies on the communication and documentation of essential information during discharge are consistently lacking in the literature [17,[32][33][34]. Kripalani et al reported in 2007 that direct communication between care settings occurred infrequently and discharge summaries often lacked details on diagnostic test results, treatment or hospital course, discharge medications, pending test results, patient counselling, and follow-up plans [35].…”

The automated patient discharge summary: improving communication at transfers of care after completion of radiotherapy

“…2,6 Several groups have studied the impact of a patient discharge summary generated at transfers in care, and have found that providing diagnosis-specific discharge summaries positively affects patient satisfaction and patient safety, improves communication among care providers, empowers patients to better self-manage their symptoms, and results in fewer hospital re-admissions. 2,7,8 For patients receiving radiation treatment, the end of a course of radiotherapy often marks a transition from active treatment, where patients are seen daily by radiation therapists, nurses and oncologists, to a period of follow-up where patient are not coming into the cancer centre on a daily basis. In particular, the 2 weeks following radiotherapy can be associated with increased side effects.…”