Abstract
Background
The discharge letter is a key component of the communication pathway between the hospital and primary care. Accuracy and timeliness of delivery are crucial to ensure continuity of patient care. Electronic discharge summaries (EDS) and prescriptions have been shown to improve quality of discharge information for general practitioners (GPs). The aim of this study was to evaluate the effect of a new EDS on GP satisfaction levels and accuracy of discharge diagnosis.
Methods
A GP survey was carried out whereby semi-structured interviews were conducted with 13 GPs from three primary care centres who receive a high volume of discharge letters from the hospital. A chart review was carried out on 90 charts to compare accuracy of ICD-10 coding of Non-Consultant Hospital Doctors (NCHDs) with that of trained Hopital In-Patient Enquiry (HIPE) coders.
Results
GP satisfaction levels were over 90 % with most aspects of the EDS, including amount of information (97 %), accuracy (95 %), GP information and follow-up (97 %) and medications (91 %). 70 % of GPs received the EDS within 2 weeks. ICD-10 coding of discharge diagnosis by NCHDs had an accuracy of 33 %, compared with 95.6 % when done by trained coders (p < 0.00001).
Conclusion
The introduction of the EDS and prescription has led to improved quality of timeliness of communication with primary care. It has led to a very high satisfaction rating with GPs. ICD-10 coding was found to be grossly inaccurate when carried out by NCHDs and it is more appropriate for this task to be carried out by trained coders.
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References
Wilson S, Ruscoe W, Chapman M, Miller R (2001) General practitioner-hospital communications: a review of discharge summaries. J Qual Clin Pract 21(4):104–108
Belleli E, Naccarella L, Pirotta M (2013) Communication at the interface between hospitals and primary care—a general practice audit of hospital discharge summaries. Aust Fam Physician 42(12):886–890
Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW (2004) “I wish I had seen this test result earlier!” dissatisfaction with test result management systems in primary care. Arch Intern Med 164:2223–2228
Coleman EA, Berenson RA (2004) Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med 141:533–536
Mageean RJ (1986) Study of “discharge communications” from hospital. Br Med J (Clin Res Ed). 293:1283–1284
Penney TM (1988) Delayed communication between hospitals and general practitioners: where does the problem lie? BMJ 297:28–29
O’Leary KJ, Liebovitz DM, Feinglass J (2009) Creating a better discharge summary: improvement in quality and timeliness using an electronic discharge summary. J Hosp Med 4(4):219–225
Alderton M, Callen J (2007) Are general practitioners satisfied with electronic discharge summaries? HIM J 36(1):7–12
Henderson T, Shepheard J, Sundararajan V (2006) Quality of diagnosis and procedure coding in ICD-10 administrative data. Med Care 44(11):1011–1019
Davie G, Langley J, Samaranayaka A (2008) Accuracy of injury coding under ICD-10-AM for New Zealand public hospital discharges. Inj Prev 14(5):319–323
Farzandipour M, Sheikhtaheri A, Sadoughi F (2010) Effective factors on accuracy of principal diagnosis coding based on International Classification of Diseases, the 10th revision (ICD-10). Int J Inf Manag 30:78–84
Kripalani S, LeFevre F, Phillips CO (2007) Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 297(8):831–841
van Walraven C, Seth R, Laupacis A (2002) Dissemination of discharge summaries. Not reaching follow-up physicians. Can Fam Physician 48:737–742
Adhiyaman V, Oke A, White AD, Shah IU (2000) Diagnoses in discharge communications: how far are they reliable? Int J Clin Pract 54:457–458
Bertrand D, Francois P, Bosson JL, Fauconnier J, Weil G (1998) Quality assessment of discharge letters in a French university hospital. Int J Health Care Qual Assur Inc Leadersh Health Serv 11:90–95
Shivji FS, Ramoutar DN, Bailey C, Hunter JB (2015) Improving communication with primary care to ensure patient safety post-hospital discharge. Br J Hosp Med (Lond) 76(1):46–49
Kind AJH, Smith MA (2008) Documentation of mandated discharge summary components in transitions from acute to subacute care. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds) Advances in patient safety: new directions and alternative approaches, vol 2: Culture and redesign. Agency for Healthcare Research and Quality (US), Rockville, MD
O’Callaghan A, Colgan MP, McGuigan C, Smyth F, Haider N, O’Neill S, Moore D, Madhavan P (2012) A critical evaluation of HIPE data. Ir Med J 105(1):21–23
Hillestad R, Bigelow J, Bower A (2005) Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood) 24(5):1103–1117
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Stephen Murphy declares that he has no conflict of interest. Laura Lenihan declares that she has no conflict of interest. Felix Orefuwa declares that he has no conflict of interest. Geraldine Colohan declares that she has no conflict of interest. Ita Hynes declares that she has no conflict of interest. Chris Collins declares that he has no conflict of interest.
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Murphy, S.F., Lenihan, L., Orefuwa, F. et al. Electronic discharge summary and prescription: improving communication between hospital and primary care. Ir J Med Sci 186, 455–459 (2017). https://doi.org/10.1007/s11845-016-1397-7
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DOI: https://doi.org/10.1007/s11845-016-1397-7