Berny Welsh · Web viewSBAR reporting from OPC attendance (Dermatology) August 2011 Billy Brant, Keith Medical Practice E Audit of medical letter dates dictated, typed and sent July

Safety Improvement in Primary Care (SIPC2) Literature Review for Out-Patient Communication

July 2011

‘OutComms’ Project, NHS Grampian, SIPC2 Steering Group, Moray

Correspondence to Project Clinical Lead:

Berny Welsh Clinical LeadAddress Telephone Number ~ 01343 567844Email ~ [email protected]

CONTENTS

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SECTION 1INTRODUCTION..................................................................................................................2

SECTION 2METHOD AND SAMPLE.....................................................................................................5

SECTION 3DISCUSSION AND CONCLUSION.........................ERROR! BOOKMARK NOT DEFINED.

SECTION 4ACTION PLAN...................................................................................................................12

ACKNOWLEDGEMENTS..................................................................................................13

REFERENCES...................................................................................................................13

APPENDICES....................................................................................................................14

DISTRIBUTION LIST.........................................................................................................16

Safety Improvement in Primary Care (SIPC2) Literature Review for Out-Patient Communication1

SECTION 1

INTRODUCTION

1.1 Good communication between primary and secondary care is very important in order to ensure seamless care for patients. 1,2

In NHS Grampian, a hand-written discharge summary (flimsy) letter is given to each patient who attends the Out Patient Clinic (OPC). The summary contains information about the admission, including, diagnosis at discharge from hospital, co-morbidities and a list of currently prescribed medicines. This summary is given to the patient to hand in to their general practitioner (GP).

Each discharge summary is followed up with a type written letter to the GP from the OPC Consultant.

1.2 Problems associated with the above system of transferring information between secondary and primary care have been recognised. These include: lack of information such as diagnosis3 , lack of continuity between medicines prescribed at discharge and those prescribed

subsequently by the general practitioner 4,5,6

medicines omission lack of medicines information 7,8,9

delays in receiving the typed discharge letter and in some cases the letter may not be received 10,11,12

discrepancy between the two letters 13

lack of information as to whom to contact if further clinical details are needed 14

Poor communication between secondary and primary care can therefore lead to errors and non-compliance by both patient and GP.

‘Communication between providers of health care is particularly important for elderly patients who might have several different diseases and multiple drug therapy regimes, and have health care provided by a number of different doctors’ (Gray 2008)

1.3 Aim of the project: To improve communication relating to the patient pathway from Out Patient

consultant treatment recommendations/management plan to patient treatment delivery in Primary Care

A subsequent aim is to streamline post referral communications from the GP around changes in patient condition and/or circumstance


SECTION 2

METHOD AND SAMPLE

2.1 Literature SearchThe Librarian in NHS Grampian conducted a search of Medline and Embase, 1996-2010 using the search terms (Family Practice OR General Practice) AND ('Correspondence as Topic' or letter* [in the abstract or title]). There were approximately 200 items in each database which were then individually looked through to narrow the search down to outpatients and the relevant articles were sent to the leads. However, there was only a small amount of evidence for the project aims.

The Clinical Effectiveness Team in NHS Grampian also reviewed their workload database to search for audits conducted on communication AND outpatients. The results were then added to the literature search.

A search on the intranet alerted the leads to the work from the Health Foundation on Out-Patient Services being planned to overhaul the service to make it more structured.


SECTION 3

DISCUSSION and CONCLUSION

3.1 Aim of the project:To improve communication relating to the patient pathway from Out Patient Consultant treatment recommendations/management plan to patient treatment delivery in Primary Care

Issues to be addressedFollowing an NHS Grampian High Level Process Mapping Event in June 2011, areas of concern were highlighted regarding the type written letter from the OPC Consultant to the GP. These issues were :

1. Timely responses 2. Inconsistencies with content3. Minimum data set4. Mode of letter – Electronic or Paper Version5. Letters being returned to patient’s registered GP rather than referring GP

Healthcare Teams can pro-actively identify potential safety breaches, enabling them to build better, safer healthcare systems’ Health Foundation 2010.

There are vast differences in practice between teams, services and organisations (Health Foundation 2010) and this was found to be the case in NHS Grampian.

The lack of standardisation was not the only common problem but an acceptance by staff of poor systems being in place and no one to take ownership of the highlighted issues. (Schabetsberger et al 2006)

3.2 1. Timely ResponsesThe BMA state that letters should be sent within a week of seeing the patient and within a maximum of 10 working days (BMA 2007).

The above timescale is related to discharge letters following hospital admission rather than OPC. Unfortunately, documented evidence for OPC is lacking but the issues appear to be very similar in nature.

An NHS Grampian Clinical Effectiveness Audit of Cardio Vascular Discharge Summaries reiterated that typed letters were better than the hand written discharge summaries and contained more information but took 2-4 weeks to reach the GP from dictation. (CE Team Audit 2008). This is obviously not an acceptable timescale when working towards the BMA guidance. As stated at the NHS Grampian High Level Process Mapping Event in June the current backlog for typed OPC letters was a minimum of 8 weeks. This is considered to be a high risk for the organisation and has major implications on Patient Safety.

2. Inconsistencies with Content‘Discharge letters are an essential part of both hospital and general practice records. They provide important information for any future inpatient and outpatient care. It is imperative that discharge letters meet the needs of general practitioners, as well as the hospital practitioner’ (Turner & Birrell 2000)


‘The general practitioner will be less able to satisfy these demands (plan of illness, investigation results, drug prescriptions) if they have not been informed of the progress of their patients’ (Lee et al 2002)

Therefore a consistent standard of documentation must be considered to ensure that a safe and risk free service can be provided to each individual.

3. Minimum DatasetSIGN 65 contains a 21 item list that should be included in a discharge document. i.e. structured format. Again this relates more to hospital discharges rather than OPC. The BMA 2007 also contains template letters for communicating with a GP. Adaptations for a minimum dataset for NHS Grampian could be collated from these with input from Consultants and GPs.

4. Mode of Letter – Electronic or Paper VersionLee et al 2002 states that paper versions seem to be an efficient way of communication, however the handwriting can be illegible and some GPs find these letters lacking in personal touch.

The Emergency Care Summary Record in NHS Grampian is to be extended to out patients. This is a key aim of ‘better health better care’ and the eHealth Strategy for NHS Scotland (ECS Lanarkshire Project 2011) Although no timescale has yet been notified of this occurrence.

It must also be noted that Data Protection, co-operation between patients and different health care institutions has a bearing on the use of Electronic Records. There is a directive 95/46/EC of the European Parliament on the protection of individuals with regard to the processing of personal data provides safeguards for the handling of sensitive data.

‘Seamless sharing of multiclinical information is a fundamental requirement for achieving continuity of care’ (Schabetsberger et al 2006)

5. Letter being returned to patient’s registered GP rather than referring GPAlthough there appears to be no written evidence of this issue, staff in NHS Grampian consider it to be good practice that the GP who referred the patient to the OPC should be informed of the patient’s results / treatment plan following attendance at the OPC rather than the patient’s registered GP. This would in fact be considered as effective patient care therefore closing the loop for the GP concerned and providing a service that is comparable to the Quality Strategy i.e. Safe, Effective, Person-centred, Timely, Equitable and Efficient.

3.3 Current Situation - What works and doesn’t work in OPCAudit work does sporadically take place around timescale for letters being dictated and typed. A specific audit will take place in Dr Gray’s Hospital to gain a baseline understanding of the current situation as this is currently unknown. The audit will capture attendance dates, dictation dates, date the letter was typed and posted for the specific clinics on-board with the SIPC2 project. Returning results to the referring rather than the registered GP and information on the letters being received at the GP Practice will be added to the audit. This work will be conducted in July 2011.

Obviously the back log of letters to be typed requires to addressed as soon as possible as this has a huge impact on the medical secretarial staffs ability to adhere to the “perceived" 10 day turnaround and goes to prove that the current system is inefficient.

Business Managers plan to investigate ways of securing shorter timescale for letters to Safety Improvement in Primary Care (SIPC2) Literature Review for Out-Patient Communication

5

be typed and sent out to GPs. Although, development of minimum dataset, mandatory fields and a SBAR / Proforma for letters whether being sent electronically or as paper versions will all contribute to a more timely response following OPC attendance.

The staff in NHS Grampian declared that basic patient information i.e. address, date of birth, CHI number etc should be utilised more efficiently in the form of patient stickers. These could easily be updated by reception staff and printed to ensure that this information is correct and present in the medical records. This also led discussion that OPC Consultants should have a legible sticker or stamp with their contact details so that any queries or concerns can be raised with that specific Consultant.

In the meantime, any issues of inadequate communication between OPC and GPs must be recorded on the DATIX Incident Recording System that is used in NHS Grampian. This information can be used to enhance the baseline audit.

3.4 Evidence1. Timely ResponsesIn a study in Royal Aberdeen Children’s’ Hospital in 1997 Lee et al discovered that existing discharge letters took on average 4 days to be received by the GP’s

The time taken from discharge to receipt of document is a major concern, with some discharge documentation not reaching the intended recipient. Delays in the receipt of the document can lead to potential problems, including errors in prescribing drugs. (SIGN 65 pg5).

Published evidence has shown that the time taken for the GP to receive discharge information is one of the possible factors contributing to medication discrepancies 12,18,19. The discharge flimsy should (and often does) contain important information about outpatient follow-up, monitoring required, dose titration etc that the GP ought be aware of to ensure that any further supplies of medication made to the patient are clinically appropriate. If this information is unavailable or delayed, then there is the potential for confusion, errors or omissions in any repeat scripts that are issued the interim period before the discharge letter is received.

Formal discharge letters took much longer to arrive in the practices (48% (20) within 2 weeks of dictation, 79% (33) within 4 weeks of dictation). 91% (29) of discharge letters were received in the practice within 8 weeks of the date of discharge from Aberdeen Royal Infirmary. The results are similar to published work 12,13 which found that approximately 50% of letters took more than 3 weeks to arrive. This delay means that it is vital that all recommendations required to be actioned in the short term are clearly stated on the discharge flimsy.

Hospital clinicians should be made aware of the importance of completing the discharge flimsy as comprehensively as possible, given the time taken for full discharge recommendations to arrive in primary care. There is of course the alternative of using email or telephoning the GP Practice.

2a. Inconsistencies with ContentGP’s were dissatisfied with content of almost 20% of them and felt the delay and lack of detail affected their management in 24% of cases. Adhiyaman 2000

In 100% of documents audited: Completeness 81% Legibility 83% No Doctors name 30%


43% dispatched within 5 days from discharge 13% difference between ward and discharge scripts 57% medication issues were picked up probably 2 weeks after! (SIGN 65)

Variations and a variety of weak spots in outpatient care particularly around management of medications, test results, and referral and follow up (Background & Significance) ‘Information most frequently missing from GP referrals relates to medication, i.e. medicines to be discontinued, over the counter medicines, routes of administration and formulation (ASHP 2005 cited in Brad Groves 2011) Also Allergies or adverse reactions to medicines and contact details for queries after discharge.

Communication regarding diagnosis or active medical problems is inaccurate in 20% of Discharge Summaries and 30% of Take Home Prescriptions (Adhiyaman 2000)

‘A promptly delivered, accurate and user-friendly letter reflects well on a department’ (Turner & Birrell 2000)

2b. Structured FormatAdams et all (Cited in Adhiyaman et al 2000) found that GP’s prefer precise and adequate information in a structured format.

Previous studies have examined general practitioner preferences for the structural aspect of letters following discharge from general medical, psychiatry, orthopaedic and oncology units.’ (Turner & Birrell 2000)

Perhaps we need to audit the preferences for a structured format so that we can review and improve the final discharge letters.

GP’s want a structured format and to email the document this will reduce both time and workload (Turner & Birrell 2000).

Typed letters prepared by senior clinicians appear to be more specific and contained a problem orientated approach or structure. However, the attendees at the Process Mapping event recognise that this varies in practice locally and wish to utilise a SBAR or Proforma which may be completed more readily with essential information.

3. Minimum DatasetDischarge letters should include ‘telephone numbers for the diagnostic service providers used by the GPC. This is intended to facilitate follow up of test results by the patient’s regular GP’ (Bolton 2001).

For nearly half of the discharge prescriptions reviewed 43% (18), the GP would not have been able to contact the hospital prescriber. This was mainly due to illegible or missing signature, bleep number or ward.

One of the ‘essential criteria’ for discharge “flimsys” recommended by SIGN20 is that the responsible person at the time of discharge should ensure that signature, legible text of name and job title are completed. In addition, a minimum requirement is that an appropriate contact telephone number should be supplied.

This was accepted by the Process Mapping attendees. Although no minimum dataset was accepted it was agreed that a proforma or SBAR should be created to acknowledge whether there was any follow up or medication changes to the GP.

4. Mode of Letter – Electronic or Paper Version


‘No formal discharge planning training is provided for UK trained doctors’ Coleman et al 2001)

Ageing population, rapidly developing technology, changing workforce profile and financial pressures (RCGP 2011)

4a. PAPER ‘A complaint from a community health visitor suggested that discharge letters from RACH often took sometime to be received causing difficulty in following up the child’s care’ (CE Team RACH A&E to HV report 2009)

A quarter (26%) of discharge “flimsys” were deemed to be ‘difficult’ or ‘very difficult’ to read. This may be due to poor handwriting or the more inherent difficulties caused by the use of quadruplicate forms.

Issues with legibility can also make it difficult to contact the prescriber.

The GP usually receives the second copy of the form and, if not enough pressure has been used, the writing can appear very faint. In addition to the obvious difficulty this poses for ensuring that appropriate treatment is provided to the patient, it can also cause operational problems in General Practices that are either ‘paper-light’ or ‘paperless’. If “flimsys” are too faint, the scanned documents cannot be read by the GP. At the time of receipt, the paper copy is still available for reference, but will ultimately be archived leaving no legible copy in the electronic record.

4b. ELECTRONICDirect Electronic transfers are the way to go in the future

Electronic systems need to be available for all areas to use but be restricted to a ‘need to know’ basis (SIGN 65) using the highest level of security.

Digital dictation is the main electronic means for outpatients to communicate to GPs at present (NHS TAYSIDE)

‘A fast, comprehensive and secure exchange of medical documents (images, discharge letters as conclusions of medical treatments) over the World Wide Web between General Practitioners and hospitals should lead to a reduction of costs, time, redundant medical services and, ideally, the duration of treatment’ (Schabetsberger et al 2006)

‘Evaluation of costs show that the reduction of costs by the replacement of paper based with electronic communication amortises the project costs already within one year’ (Schabetsberger 2006)

The speed of receiving information from the hospital is of the utmost importance for GP’s as is the importance of details being missing from the document.

The Referral Management System has the facility to allow a specialist to send a message back to the referrer (may be treatment advice, request for investigations pre clinic, or request for further information etc).(TAYSIDE)

‘Electronic solutions have, in some cases, added to frustration and have even led practices to defer tackling process re-engineering awaiting software changes or electronic solutions that they perceive are beyond their immediate control’ (Background and Significance)

5. Letter being returned to patient’s registered GP rather than referring GPSafety Improvement in Primary Care (SIPC2) Literature Review for Out-Patient Communication

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Unfortunately, no published evidence on this has been found.

3.5 Aim of the Project: A subsequent aim is to streamline post referral communications from the GP around changes in patient condition and/or circumstance

Post referral communicationsIssues to be addressedThis issue was briefly touched on at the High Level Process Mapping event in June 2011. Areas of concern were highlighted regarding as :

1. Timely responses 2. Different ways of handling discharge information in each practice3. Ongoing Patient Care4. Standardising the patient care process5. Involving others i.e. Pharmacist

Current Situation – What works and what does not work1. Timely responses The GP’s recognised that the timeliness of discharge information arriving at the Practice has a knock on effect for patient care with some patients attending the GP Practice for medication changes or results without the GP having the information from the hospital / Out Patient Clinic.

2. Different ways of handling discharge information in each practiceWhilst working with the Practices a flow chart was compiled by the project leads to monitor the way that discharge information from OPC is handled. It appears that two practices have very different ways of handling the communication i.e. One Practice scan all documentation into DOCMAN before actioning by the GP, whilst another Practice ensure that the actual letter and actions are resolved before scanning by the administration staff.

3. Ongoing Patient CareThe GP has to ensure that the patient gets the treatment advised. This will frequently involve initiating management of a long term condition, or modifying the plan for a pre-existing condition. Many patients with long term conditions receive much of their structured care via nurse run clinics in General Practice.

4. Standardising the Patient Care ProcessThere are a number of ‘hand offs’ of care between the OPC Consultant suggesting a management plan and the patient finally getting the treatment. This increases the risk of errors. The most useful way of looking at communication from the OPC therefore needs to look at the complete pathway, from the patient’s perspective.

5. Involving Others i.e. Pharmacist

Evidence1. Timely responses ‘50% of recently discharged patients contacted their general medical practice before any discharge information arrived ‘pg 227 Coleman et al 2001

2. Different ways of handling discharge information in each practiceSafety Improvement in Primary Care (SIPC2) Literature Review for Out-Patient Communication

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Referrals from GPs are received electronically via SCI Gateway and handle them electronically within the Referral Management System. (NHS TAYSIDE) ‘Primary Care Clinicians should ensure that robust systems are in place both for dealing with immediate recommendations of discharge communications and subsequent requirement for ensuring patients’ medical records are updated.’ (CET CVA Audit 2008)

3. Ongoing Patient Care‘Out patient services need a radical re-think’ (Health.org.uk)

Anticipate issues before they happen.

Primary care clinicians should ensure that robust systems are in place both for dealing with the immediate recommendations of discharge communications and the subsequent requirement for ensuring patients’ medical records are updated. This in turn will help to ensure accurate information is available to hospital clinicians, should a patient be re-admitted or referred for a specialist consultation.

‘There should be greater recognition of the value of patient engagement, including the work of patient groups, in helping individual practices to provide the care their community needs. Practices must be actively encouraged to develop patient groups in their practices to improve communication and understanding of patient needs’ (RCGP 2011)

4. Standardising the Patient Care Process‘The ambulatory setting is rife with error prone processes. In addition, given the nature of preventable harm and the relatively longer time frame in the outpatient setting, there are often opportunities for earlier identification of problems and interventions before serious harm occurs.’ (Background & Significance SIPC2)

5. Involving Others i.e. Pharmacist‘The Royal Pharmaceutical Society of Great Britain’s guidance on discharge and transfer planning (2006) recommended providing community pharmacists (as well as patients and GPs) with information on discharge medication to prevent adverse effects and reduce readmissions.’ (Gray 2008)

Discharge letters are routinely sent to the patient’s GP but ‘also sent to the patients, or their carer, as well as other healthcare professionals if necessary, but not routinely to pharmacists.’ (Gray 2008)

A cohort study found that sending a copy of the discharge document to a community / practice pharmacist reduced the discrepancy rate from 52.7% to 32.2%. (SIGN 65 pg 5).

Patients were more likely to get the treatment recommended by the consultant as a result of the change in practice: 83% compared to 51%. Consultants recommendations were not fully implemented in 7% after compared to 29% before the change.Many more patients were getting the treatment recommended by the consultant

All pharmacists and the consultants were ‘very positive’ about the change and pharmacists felt more integrated into their local healthcare team. (Gray 2008)

In the pipeline we are working on a version of our inpatient electronic discharge system that will be a 'lite' outpatient friendly application to manage outpatient prescriptions (with full pharmacy functionality as with the inpatient EDD) and communicate a report to GPs. (NHS TAYSIDE)

SummarySafety Improvement in Primary Care (SIPC2) Literature Review for Out-Patient Communication

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One in 10 patients admitted to hospital will experience some form of harm during their stay. In nearly every case the problem is caused by unreliable healthcare systems and processes’ (Health Foundations 2010)

‘Need to make systems and processes ,more reliable across the NHS in order to make care safer for patients’ (Health Foundation 2010)

Out Patient ClinicsOutpatient services are one of the largest areas of hospital provision. As such, they utilise a significant amount of hospital facilities, resources and staff. (Health.org.uk)

Communication‘Many Studies have been carried out to assess how to improve communication between clinicians in hospitals and those in the community (Lee et al 2002)

‘Communication between general practice, hospitals and specialists needs to be faster and more efficient. There must be better teamwork and collaboration between general practice, hospitals, the ambulance service and social care to make the best use of scare resources.’

GPGP’s want to spend more time with patients, genuine shift to provide more care in the community, better communication between GP and hospital and equitable care for all (RCGP 2011)

‘There should be greater recognition of the value of patient engagement, including the work of patient groups, in helping individual practices to provide the care their community needs. Practices must be actively encouraged to develop patient groups in their practices to improve communication and understanding of patient needs’

GP’s are natural leaders and innovators in their practices; skills could be used more widely in NHS in Scotland (RCGP 2011)

Ideally placed to provide practical solutions in partnership with patients, Scottish Government, Health Organisations and 3rd sector organisations and the public (RCGP 2011)

ConclusionWith assistance from the SIPC2 Programme and the ‘OutComms’ Project Team the issues highlighted will be addressed by the five Practices in NHS Grampian to ensure that patient care is in line with the Quality Strategy.


SECTION 4

ACTION PLAN

Action Date by which action will be accomplished

Person responsible for

overseeing action5.1 Dissemination of results July 2011

5.2 Determine a baseline to see what is happening in Moray by Process Mapping also a questionnaire has devised and will be disseminated to the GP Practices involved in the SIPC2 programme

June 2011

A Electronic proforma to be developed and tested. (This is the initial paper letter handed to pt at OPC, issues with legibility, consultant ID, patient minimum data set)

July 2011 Louise Black

B Consultant labels July 2011 Jenny Walten, Karen Thomson, Louise Black

C Patient labels July 2011 Karen Thomson, Louise Black, OPD Staff, Medical Records Staff

D SBAR reporting from OPC attendance (Dermatology)

August 2011 Billy Brant, Keith Medical Practice

E Audit of medical letter dates dictated, typed and sent

July 2011 Ken Hamilton

F Snapshot audit of letters being received at practice

July 2011 Louise Black and all Practice admin staff

5.3 Determine what the process is in our neighbouring Health Boards in Scotland – Information received from Tayside, awaiting reply from Highland

April 2011 Jude Scott and Louise Black

5.4 Discharge Policy for Moray?


ACKNOWLEDGEMENTS

REFERENCES1 Adhiyaman, V., Oke, A., White, A.D., et al 2000, "Diagnoses in discharge

communications: how far are they reliable?.", International journal of clinical practice, vol. 54, no. 7, pp. 457-458

2 Bolton, P. 2001, "A quality assurance activity to improve discharge communication with general practice.", Journal of quality in clinical practice, vol. 21, no. 3, pp. 69-70

British Medical Association (BMA). 2007. “Improving Communication, the exchange of information and patient care” BMA, London

3 Coleman, A., Ricketts, L., Teal, S., et al 2001, "An audit of hospital discharge and outpatient information from a primary care perspective.", Journal of Social and Administrative Pharmacy, vol. 18, no. 6, pp. 226-231

4 Fox, A.T., Palmer, R.D., Crossley, J.G.M., et al 2004, "Improving the quality of outpatient clinic letters using the Sheffield Assessment Instrument for Letters (SAIL).", Medical education, vol. 38, no. 8, pp. 852-858

5 Gray, S., Urwin, M., Woolfrey, S., et al 2008, "Copying hospital discharge summaries to practice pharmacists: does this help implement treatment plans?.", Quality in Primary Care, vol. 16, no. 5, pp. 327-334

6 Grove, B. 2011 “Summary Report: Medicines Reconciliation at Discharge from Hospital” Edinburgh

7 Health Foundation. 2010 “Snapshot – Safer Clinical Systems”, The Health Foundation, London

8 Health Foundation. 2011 “Evidence in Brief: Do quality improvements in primary care reduce secondary care costs?”, The Health Foundation, London

9 Health Foundation. 2011 “Outpatient Care – Improvement Report - Overview”, The Health Foundation, London

10 Kung, K., Lam, A. & Li, P.K.T. 2007, "Referrals from general practitioners to medical specialist outpatient clinics: Effect of feedback and letter templates.", Hong Kong Practitioner, vol. 29, no. 9, pp. 357-364

11 Lee, M.S., Nunez, D.A. & Lamont, H.J. 2002, "Audit of a change in otolaryngology discharge letters using the Scottish Intercollegiate Guidelines Network (SIGN) recommendations.", Scottish medical journal, vol. 47, no. 5, pp. 109-111

12 Mead, G.E., Cunnington, A.L., Faulkner, S., et al 1999, "Can general practitioner referral letters for acute medical admissions be improved?.", Health bulletin, vol. 57, no. 4, pp. 257-261


13 Middleton, S., Appleberg, M., Girgis, S., et al 2004, "Effective discharge policy: are we getting there?.", Australian Health Review : A Publication of the Australian Hospital Association, vol. 28, no. 3, pp. 255-259

14 NHS Grampian. 2008, “Audit of Cardiovascular Unit Discharge Recommendations” Clinical Effectiveness Team, NHS Grampian, Aberdeen

15 NHS Grampian. 2009, “Communication from RACH A&E Department to Community Health Visitors” Clinical Effectiveness Team, NHS Grampian, Aberdeen

16 NHS Grampian. 2008, “Audit of the Accuracy and Effectiveness of Referral Letters to Gynaecology Service – Heavy Menstrual Bleeding / Post Menopausal Bleeding / Urinary Incontinence” Clinical Effectiveness Team, NHS Grampian, Aberdeen

17 NHS Scotland. 2011, “ECS-Lanarkshire Project – Emergency Care Summary (ECS) and Medicines Reconciliation in scheduled care – Final Report (v5.8)” NHS Scotland, Edinburgh

18 Royal College of General Practitioners Scotland (RCGP), 2011 “General Practice: A Manifesto for Patient Care in Scotland” RCGP Scotland, Edinburgh

19 Sackley, C.M. & Pound, K. 2002, "Stroke patients entering nursing home care: a content analysis of discharge letters.", Clinical rehabilitation, vol. 16, no. 7, pp. 736-740

20 Schabetsberger, T., Ammenwerth, E., Andreatta, S., et al 2006, "From a paper-based transmission of discharge summaries to electronic communication in health care regions.", International journal of medical informatics, vol. 75, no. 3-4, pp. 209-215

21 Scottish Intercollegiate Guidelines Network, 1998 “(SIGN) 31 Report on a Recommended Referral Document” SIGN, Edinburgh

22 Scottish Intercollegiate Guidelines Network, 2003 “(SIGN) 65 The Immediate Discharge Document” SIGN, Edinburgh

23 Turner, S. & Birrell, G. 2000, "What do general practitioners and paediatricians want from discharge letters?.", Ambulatory Child Health, vol. 6, no. 3, pp. 147-151


CHECK REFERENCES

BIBLIOGRAPHY1 Scottish Government website – Electronic Palliative Care Summary (ePCS) available at:

http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/LivingandDyingWell/ePCS

1 Our National Health. A plan of action, a plan for change. Scottish Executive Health Department 2002.

2 Clinical standard board for Scotland. Promoting public confidence in NHS. January 2001. www.clinicalstandards.org

3 Adhiyaman V, Oke A, White AD, Shah IU. Diagnosis in discharge communications:how far are they reliable? International Journal of ClinicalPractice 2000 54(7): 457-458.

4 Cochrane RA, Mandal AR, Ledger-Scott M, Walker R. Changes in drug treatment after discharge from hospital in geriatric patients. British Medical Journal 1992;305:694-696

5 Burns JMA, Sneddon I, Lovell M, McLean A, Martin BJ. Elderly Patients and Their Medication: A Post-discharge Follow-up Study. Age Ageing 1992; 21:178-181.

6 Duggan C, Bates I, Hough J. Discrepancies in prescribing - where do they occur? The Pharmaceutical Journal 1996; 256:65-67.

7 Duncan J. Assessing incoming discharge letters. Primary Care Pharmacy 2000;1(4):109-111.

8 Randles AJ, Black PE. An investigation into the role of a practice pharmacist in the processing of discharge medication in one GP practice. The Pharmaceutical Journal 1999;263:R65.

9 Davie A. Medication on discharge from hospital :a study of discrepancies between discharge and GP-held information, and a review of general practice procedures for dealing with discharge communication. MSc thesis, School of pharmacy, Robert Gordon university May 2006

10 Penney TM. Delayed communication between hospitals and general practitioners: where does the problem lie? British Medical Journal 1998;297:28-29.

11 Wilson S, Ruscoe W, Chapman M, Miller R. General practitioner-hospital communications: A review of discharge summaries. Journal of Quality in Clinical Practice 2001;21:104-108.

12 Foster DS, Paterson C, Fairfield G. Evaluation of Immediate Discharge Documents - Room for Improvement? Scottish Medical Journal 2002;47:77-79.

13 Coleman A, Ricketts L, Teal S, Mitchell E, Silcock J, Wright DJ. An Audit of Hospital Discharge and Outpatient Information from a Primary Care Perspective. Journal of Social and Administrative Pharmacy 2001;18(6):226-23.

14 British Medical Association. Annual Report of council 2000-2001.

15 Cunningham G, Dodd TRP, Grant DJ, McMurdo MET, Richards RME. Drug-related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent reassessment. Age and Ageing 1997;26:375-382.

16 Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18820 patients. British medical journal 2004;329:15-19

17 Mannesse CK, Derkx FHM, De Ridder MAJ, In'Tveld AJM, Van der Cammen TJM. Contribution of adverse drug reactions to hospital admission of older patients. Age and


http://www.clinical/

Ageing 2000;29:35-39.192021

APPENDICES

Appendix 1 - E.g. DATA COLLECTION FORM / questionnaire

NHS Grampian PositionIt must also be acknowledged that the leads are aware that NHS Grampian is currently involved with Electronic Palliative Care Summary (ePCS) which is run by the Scottish Government and has been rolled out throughout Scotland which aims to promote the communication between a dying patient’s wishes, GP’s and Out of Hours services. Please see the link below for more details:http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/LivingandDyingWell/ePCS

On the 14th February 2011, a new TrakCare Patient Management System (PMS) was introduced in NHS Grampian. Grampian is one of the first five Boards across Scotland to implement the system. Over the course of a 2 year implementation programme, PMS will replace the current Patient Administration System (PAS), Mental Health (PIMS) and Maternity (PROTOS) systems as well as introducing a host of other clinical functionality such as the ability to electronically request and result Laboratory and Radiology investigations and the ability to support the Referral To Treatment Pathways (RTT).

From an information aspect, 3 years from now, NHS Grampian's acute services are expected to be functioning predominantly utilising electronic means. This means that all patient administration (including pre-assessment and theatre management) will be electronic, the majority of the patient's health record will be accessible electronically, bed management will be achieved using electronic means and clinicians will have the ability to request laboratory /radiology tests electronically and electronically record the action taken following receipt of the results. PMS will be a key system in this vision alongside other key/national systems such as Opera (Theatres system), Badger Net (Maternity and Neonatal system), Carestream (radiology system), Labs and SCI Gateway to name a few.


http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/LivingandDyingWell/ePCS

Appendix 1


DISTRIBUTION LIST

Electronic Version of Report and Executive Summary distributed to:

(Add own list onto this one!)
