Introducing a Framework for Surgical Discharge Summaries to Improve Accuracy and Succinctness in a Busy District...

Background Discharge summaries (TTOs) are essential documents in the effective communication between primary and secondary care, particularly in conveying critical post-discharge instructions to patients. Inconsistencies and omissions in TTOs can significantly undermine patient outcomes and disrupt continuity of care. This is particularly relevant to surgical patients, who often require specific follow-up care such as the removal of clips or drains shortly after discharge. Following the recent transition from paper-based to electronic records at a busy district general hospital (Royal Blackburn Hospital, Blackburn), the quality of TTOs was noted to be substandard. This quality improvement project aimed to enhance the accuracy and clarity of surgical TTOs.  Methods A targeted framework was developed in collaboration with local consultants and the consideration of national guidelines to guide the content of surgical TTOs, focusing on five essential components: Reason for Admission, Intervention, Surgical Details, Discharge Plan, and Follow-up Instructions. Initial retrospective data analysis included TTOs (n=60) across five surgical wards, evaluating their quality against the framework. The framework was then introduced via educational initiatives and integrated into the hospital's electronic patient record (EPR) system (CERNER). The impact of these interventions was assessed through data collection after two Plan-Do-Study-Act (PDSA) cycles.  Results Baseline data highlighted significant deficiencies; 42 (70%) of TTOs were missing at least one key element, with missing follow-up details most often the reason. Many TTOs also included excessive or inappropriate information, and their format varied greatly depending on individual writing styles. Following the first PDSA cycle and the introduction of the framework, the number of TTOs containing all essential data points increased by 14 (30% increase), while those missing two or more elements decreased by 16 (48% decrease). After the second cycle, further improvements were observed, with the number of TTOs missing one or more data points decreased by 6 (21%). Despite the overall progress, follow-up information continued to be the most frequently omitted element. Feedback from resident doctors was positive and the unanimous opinion was that the framework improved not only the quality of TTOs, but also how efficiently they were written.  Conclusions Implementing a standardised framework significantly improved the quality of surgical TTOs, particularly by increasing the inclusion of critical information. These results are encouraging. However, anecdotal evidence suggests there is a lack of training in writing TTOs at both undergraduate and foundation levels. Ongoing efforts are required to address these areas to ensure a sustained improvement in quality.