Patients at risk in Wales over poor discharge from hospital
THE “disjointed” and “fragmented” process of discharging patients from hospital back under the care of their GP could be putting them at risk of harm.
That’s according to a new report by Healthcare Inspectorate Wales (HIW) which highlighted concerns over the quality and timeliness of discharge provided by NHS hospitals across the country.
It said that while health boards and trusts had the correct discharge policies in place, there appeared to be a “lack of awareness and understanding” of the processes by staff on hospital wards.
This lack of clarity, combined with poor IT infrastructure and a failure by healthcare professionals to take responsibility for effective communication, could be putting patients at risk, inspectors warned.
In addition, the report noted confusion over how much patient information should be shared between the hospital and GP surgery.
There were also worries that patients were not being given clear instructions from hospital staff about how to take their medication, or of any potential side-effects. But it did find that more ward-based pharmacies helped improve patients’ knowledge of the medication they were taking home.
The report states: “Poor discharge can lead to poor outcomes for patients and for their loved ones. It is essential that each professional involved in a patient’s care needs to take professional responsibility and accountability in ensuring that they play their part in the patient’s pathway.
“The challenges within this report need to be overcome in order to ensure that the necessary improvements are made across Wales.”
The HIW report found that the relationship between hospitals and GP surgeries was not close enough and caused a weakness in the discharge system.
It also concluded that physiotherapists and occupational therapists were “under-utilised” within current discharge processes and could have helped reduce the workload for others.
And while the use of e-discharge (electronically recording discharge) had a positive impact on both quality of information and timeliness of receipt by GPs, there were still instances of sparse or incomplete information being provided. In some cases, inspectors noted that discharge information was still sent to GPs by fax.
The report stated: “We found frustration among healthcare staff at the inadequacies of their organi- sation’s IT systems undermining their ability to use e-discharge effectively...
“For technology to be truly effective, IT systems across Wales need to be integrated, however it is important to reiterate that for this to happen there is a clear need to be realistic about what is required and the timeframes needed for implementation.
“What can be improved regardless of IT and e-discharge systems, is the relationship between secondary care and general practice. Bringing this relationship closer will see an improvement in understanding roles and responsibilities, as well as opening channels for ongoing dialogue to raise concerns and share best practice.”
From February 2015 to October 2017, the Public Services Ombudsman for Wales conducted 15 investigations where patient discharge was referenced in a significant way.
HIW has made 13 recommendations for NHS Wales to consider as result of these findings. One was to ensure that junior doctors should receive discharge training “as a priority” and scheduled within the first week of induction.
HIW chief executive Dr Kate Chamberlain said: “Our review recognises the commitment of staff to improve management of patient discharge, with some examples seen of good practice being developed across Wales. However, the overall picture is variable, with a fragmented approach being taken across Wales and local initiatives and tools being developed in the absence of national solutions being implemented.”
Dr Martin O’Donnell, vice-chairman of the Royal College of GPs in Wales, said: “Patient discharge arrangements are a common source of frustration for patients and they can be frustrating for GPs as well. When they leave hospitals, patients are not discharged from care, rather their care is transferred back to primary care.
“Good information-sharing can ensure patients experience continuity of care even when they’re seeing different healthcare professionals. When a patient leaves hospital, GPs need to have the right type of information, particularly around medication and any significant developments during the stay. Often this isn’t the case.
“Information also needs to be transferred in the right way; it shouldn’t be a surprise that electronic discharge delivers improved outcomes. It’s further evidence of the NHS being held back because of a lack of IT and technology.”
A Welsh Government spokesperson said: “The report recognises electronic discharge has had a positive effect in Wales. The Medicines Transcribing and e-Discharge (MTeD) system is currently being rolled out to all hospitals in Wales, providing GPs with immediate access to high-quality electronic discharge information.
“We are also increasingly sharing this information with patients’ nominated community pharmacists to ensure that any changes to medicines made in hospital are continued in the community. We are also commissioning a review of ICT infrastructure in NHS Wales. We will consider the findings of the report.”