1. Royal College of Obstetricians and Gynaecologists Setting standards to improve women’s health Risk Management and Medico-Legal Issues In Women’s Health Joint RCOG/ENTER Meeting Please turn off all mobile phones and pagers

2. Good Communication is the Key to Delivering High Quality Clinical Care and Reducing Complaints Dr M Adishesh, ST1 Trainee Mr. EC Nwosu, Consultant Obstetrician and Gynaecologist, Whiston Hospital

3. Introduction ‘Sharing information with other healthcare professionals is important for safe and effective patient care’ GMC, Good medical Practice(2006) ‘ The immediate discharge document is an important instrument for effective communication between secondary and primary care ’ SIGN guideline no 65 The Immediate Discharge Document(2003)

4. Background  Recently received complaints from GP’s regarding emergency summaries / not received / not legible/ contain inadequate information  Formal discharge letters - take time to reach GP’s Formal dictation Typing Signature Postage  To reduce delay, hand written discharge summaries are completed (in triplicate) by doctors First copy - given to patient to give to GP Middle copy - faxed to GP Third copy - filed in patient notes

5. Aims and Objectives  To assess the quality of emergency discharge summaries to general practitioners  Determine reasons for complaints  Make recommendations required to improve communications

6. Materials and Methods  Prospective study  Obstetrics & Gynae Unit – Whiston Hospital Affiliated to Univ of Liverpool  Information was gathered from 100 emergency discharge summaries completed by junior doctors in the unit  Over three months period ( Dec 07-Feb 08)  10 summaries were used as controls and faxed (5 top & 5 middle copies) to an in-house number to check the quality of faxed materials received by GP’s

7. Information abstracted  Full patient details  Consultant  Date of admission and discharge  Diagnosis  Procedure / complications  Treatment  Follow up arrangement  Signature / legibility / status

8. Results – General Details

9. Admission details

10. Diagnosis and other details

12. Conclusions  Discharge summaries completed appropriately, there is room for improvement  84 % of cases had correct GP details  Some GP’s didn’t receive the communication Patients failed to hand in discharge summary to GP Incorrect GP fax number Surgery had moved  Only 50% of faxed summaries (control) were legible All top copies were legible Middle copies - usually faxed to GP’s were not very legible (main cause of complaints)

13. Recommendations  Ensure all aspects of discharge are completed adequately  Top copy of triplicate form be faxed to GP’s  ? Followed by a phone call / diffic weekends /  One copy discharge summary (only), filed in patients notes after being faxed to GP for: - consistency /environ friendly / reduce complaints  Use electronic discharge summary system that can be electronically sent to improve consistency, compliance and legibility (issue already being addressed by Trust)  Communicate with GP’s to update unit regularly with their surgery details on relocation and telephone & Fax details  Re- audit in 12 months

14. Thank You For Listening Any Questions ?

15. Royal College of Obstetricians and Gynaecologists Setting standards to improve women’s health Risk Management and Medico-Legal Issues In Women’s Health Joint RCOG/ENTER Meeting Please turn off all mobile phones and pagers