1. Results Conclusions Good compliance with writing TTOs however there is room for improvement with adherence to filling in certain information parameters as per the national standard Suggestions for improvement: Raise awareness and importance of writing discharge summaries and sending them by highlighting that delivering this information on time is part of effective health care and responsibility of the health care professional writing/printing summary Highlighting estimated date of discharge so discharge summaries can be done in a timely manner Modifications in extra med discharge format (e.g. add bleep no, why change medication) as mandatory requirements to ensure that information is filled in Having different sections for different categories of healthcare professionals e.g. A separate section for OT/PT/Dietitians so they can add their input Re audit to continue the quality improvement By doing this, trusts will take a step towards achieving their Commissioning for Quality and Innovation targets and will ensure that patients and GPs are better informed about their care and any after care needed. In the long term, this will improve the information provided to patients and create a better way of patients and GPs working together in an informed manner, and in turn could result in a reduction of readmissions. References “Electronic 24hr discharge summary implementation”, Clinical record standards. Health and Social care information centre. (http://systems.hscic.gov.uk/clinrecords/24hour) Accessed 10/10/2014 Abstract A standardised electronic discharge summary enables the continuous care of patients once they have been discharged from hospital, with consistent and relevant information in the right place in a timely manner. The Clinical Data Standards Assurance programme began a project to deliver a national, clinically-assured electronic discharge summary to the GP within 24 hours of the patient being discharged from hospital. The aim of this audit was to assess compliance of the acute medical wards to the nationally-agreed discharge summary headings as approved by the Royal College of Physicians professional record keeping standards work published by the Academy of Medical Royal College. Introduction In August 2010, the Clinical Data Standards Assurance programme began a project to deliver a national, clinically-assured electronic Discharge Summary to the GP within 24 hours of the patient being discharged from hospital. This discharge summary was intended to be structured, standardised and generic thus, having the ability to be sent electronically from any acute hospital electronic health record system. Discharge summaries are a means to deliver effective health care by sharing accurate, valid and critical patient information with the general practitioners in a timely fashion. The inability to share information leads to unnecessary duplication of tests and delays in patients receiving appropriate treatment with potentially serious consequences which threaten both the patient safety and quality of care being provided. This aim of this project was to look at local practice by reviewing the discharge summaries being issued from acute medical wards to assess if we are achieving the targets set by the Clinical Data Standards Assurance Programme in delivering complete and accurate information that meet the needs of the GP and patient. Methodology Audit standards: The Royal College of Physicians professional record keeping standards work published by the Academy of Medical Royal College discharge summary headings. A questionnaire was designed using the audit standard which focused on the following headings: 1)TTO Done or not 2)Date of Discharge documented 3)Text satisfactory 4)Presentation 5)Investigation 6)Discharge Destination 7)Diagnosis 8)Allergies documented 9)Medication On Discharge 10)Any medication changes documented clearly 11)Any medication stopped documented clearly 12)Follow up 13)Sender name 14)Bleep/Contact no 15)Job title 16)If patient died –was GP informed 17)TTO Send late The sample comprised of cross checking medical discharge summaries from acute care wards in Broomfield Hospital over a fixed period in patients whose length of admission was > 24 hours. Data was collected prospectively. Electronic 24-hour discharge summary National Standard for Patient Discharge Summary Information Health Information and Quality Authority Dr H. Iftikhar, Dr S. Saber, Dr B. Band, Dr A. Qureshi Department of Elderly care, Broomfield Hospital Mid Essex Hospital NHS Trust INITIAL AUDITQUALITY IMPROVEMENT YESNOYESNO TTO DONE 92%8%94%6% DATE OF DISCHARGE DOCUMENTED 68%32%94%6% TEXT SATISFACTORY 89%11%94%6% PRESENTATION 93%7%94%6% INVESTIGATION 89%11%90%10% DISCHARGE DESTINATION 83%17%94%6% DIAGNOSIS 76%24%78%22% ALLERGY DOCUMENTED 76%24%74%26% MEDICATION DISCHARGE 72%20%92%2% MEDICATION CHANGE DOCUMENTED 23%26%92%2% MEDICATION STOPPED DOCUMENTED 13%21%90%4% FOLLOW UP 69%31%80%20% SENDER NAME 93%7%98%2% BLEEP NO 1%99%2%98% JOBTITLE 93%7%98%2% PATIENT DIED GP INFORMED 0%2%0% TTO SEND LATE 16% 14% TTO done but not sent = 22%