New one-page discharge summary for patients trialled
SYDNEY: Many patients find being discharged from hospital deeply confusing. Can a new patient letter address the issue?
Once discharged from hospital, many patients are understandably bewildered about exactly what just happened.
They might receive a medication list and a pamphlet about their condition. Their GP will receive a discharge summary.
But for those patients who want to be actively involved in their own medical care and recovery, the medical jargon and fragmented communication can be a major barrier. Not only that, but a lack of knowledge can lead to patients failing to properly manage their medical issues, potentially leading to readmissions.
It is for that reason that Professor Geoffrey Tofler, a cardiologist at Sydney’s North Shore Private Hospital, is trialling a one-page patient directed discharge letter (PADDLE) aimed squarely at improving how much patients understand about their hospital stay.
‘We want the patient to get this letter prior to discharge, given to them by hand and discussed with them. It would come with the medication list and the GP discharge summary,’ he said.
‘There’s evidence that if people are confused and don’t have a good understanding of what happened in hospital and don’t have a good idea what to do at home, it can have adverse outcomes like not following instructions or being readmitted to hospitals.
‘When you see patients in hospital, there’s a lot going on. I’d like to think I explain what happened in detail, but we know that patients forget things.
‘It’s the same when I take my car to the mechanic – he explains what happened, I nod as if I understand, but I may not.
‘A lot of the words [doctors] use, we think they’re well known. But usually, in fact, it’s not so clear and the patient may hear something different.’
Professor Tofler said there is an increasing focus on patient knowledge and control of the medical process.
‘Discharge summaries are written for GPs, and so often the language used is not at the level of the patients. We felt that was a gap we could help with,’ he said.
‘I’d like to think that every patient would benefit from a PADDLE [letter].’
The three-hospital trial received $200,000 in funding from the HCF Research Foundation to refine the letter and test whether it reduces readmissions and adverse events.
The move comes after Professor Tofler’s team ran a pilot study in 2014, finding that a one-page letter to patients did indeed aid their understanding of what had happened and what they should do to manage their condition.
A key issue that emerged from that trial was the challenge of how to get these letters written in a timely and accurate fashion. There has also been a widespread push, as evidenced by recent reports, by GPs to reframe discharge summaries as clinical handovers.
‘With busy residents and time pressures, it’s difficult to fit it in. That was the challenge, how to fit this in in terms of timing, given it’s an extra time component,’ Professor Tofler said.
To help time-poor hospital residents – who tend to be given the task of writing discharge summaries – Professor Tofler and his team have experimented with automating the letter production as much as possible by producing templates for common conditions, using layperson terminology proven to be understandable.
A letter for a heart attack is a one example:
‘You came in with chest pains, short of breath and sweaty. Your ECG showed changes suggesting a heart attack and this was confirmed by a troponin blood test … You’ve been started on two medications and a cholesterol lowering tablet. The nurse has given you a pamphlet to look at and arranged rehabilitation classes. When you are back home, take the medications on your medication list. Don’t drive for two weeks and avoid heavy exercise for six weeks. Your follow up appointments with your GP are listed. If you have any concerns or questions, speak to your GP.’
Professor Tofler hopes the trial will show that the PADDLE letter is both feasible and useful, and will lead to widespread adoption of a patient discharge letter produced alongside the GP discharge summary.
‘We will encourage patients to show it to their family, and we’d be happy if they showed it to their GP as well,’ he said.
