Royal College of Obstetricians and Gynaecologists

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Royal College ofObstetricians andGynaecologists
Setting standards to improve womens health
Risk Management and Medico-Legal Issues In
Womens Health Joint RCOG/ENTER Meeting
Please turn off all mobile phones and pagers
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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

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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)

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Background

• Recently received complaints from GPs regarding
  emergency summaries / not received / not
  legible/ contain inadequate information
• Formal discharge letters - take time to reach
  GPs
• 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

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Aims and Objectives

• To assess the quality of emergency discharge
  summaries to general practitioners
• Determine reasons for complaints
• Make recommendations required to improve
  communications

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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
  GPs

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Information abstracted

• Full patient details
• Consultant
• Date of admission and discharge
• Diagnosis
• Procedure / complications
• Treatment
• Follow up arrangement
• Signature / legibility / status

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Results General Details
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Admission details
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Diagnosis and other details
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(No Transcript)
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Conclusions

• Discharge summaries completed appropriately,
  there is room for improvement
• 84 of cases had correct GP details
• Some GPs didnt 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 GPs were not
  very legible (main cause of complaints)

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Recommendations

• Ensure all aspects of discharge are completed
  adequately
• Top copy of triplicate form be faxed to GPs
• ? 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 GPs to update unit regularly
  with their surgery details on relocation and
  telephone Fax details
• Re- audit in 12 months

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Thank You For Listening

• Any Questions ?

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Royal College ofObstetricians andGynaecologists
Setting standards to improve womens health
Risk Management and Medico-Legal Issues In
Womens Health Joint RCOG/ENTER Meeting
Please turn off all mobile phones and pagers