[Written information from hospital to primary physician about discharged patients]

Discharge communications from hospitals to general practitioners in respect of 203 patients have been analyzed in two municipalities in Western Norway. The average interval between discharge from hospital and the first visit to the GP was 25 days (1-198 days). The mean period before arrival of the final report was 28 days (0-175 days). In 38% of the cases the GPs had received no written communication from the hospital upon first contact after discharge. 42% of the preliminary reports and 18% of the final reports were judged to be inadequate. At the first attendance, the GPs were uncertain about the drug regimen in 25% of the cases and about other forms of treatment in 32%. They felt uncertainty about follow-up procedures in the case of 44%. As evaluated by the GPs, in 22% of the cases the absence or inadequacy of the discharge letters might have had a negative influence on the patient's health. A survey of the literature provides a basis for the following recommendations: On leaving the hospital the patient should be given an interim discharge summary containing any information essential for immediate follow-up, to be delivered to the general practitioner by hand. The final discharge letter should focus upon topics of particular interest for the general practitioner: results from clinical examinations and laboratory investigations should be restricted to data necessary for making clinical decisions; treatment given in hospital, including adverse reactions, and drug regimen at discharge; any information on the nature and prognosis of the disease given to the patient and/or relatives during the stay in hospital; evaluation of prognosis and advice on sociomedical rehabilitation in everyday life and at work; a plan for future management of the patient with emphasis on well-defined sharing of tasks and responsibilities between the hospital, the outpatient department and the GP.