A report from the Health Services Safety Investigations Body finds that patients suffer harm as electronic communications fail to support their safe discharge from hospital.
Patients are coming to harm due to failures in the way critical clinical information is electronically communicated when they are discharged from hospital.
A report from the Health Services Safety Investigations Body (HSSIB) has focused on the risks associated with the electronic discharge summary – the primary tool for transferring clinical information about patients from hospitals to primary and community care.
It found that vital information about diagnoses, medications and necessary follow-up care is often delayed, incomplete, or missed altogether, which has led to incidents of patient harm after hospital discharge.
“We heard throughout the investigation about the distressing impact on patients and families when care is not followed up,” said senior safety investigator Nick Woodier.
“One thing we have heard from several families is that when there are gaps in information, they are left to take on the responsibility of ensuring the right information is communicated to the right place for their loved ones. They felt they didn’t have support from healthcare organisations.”
Gaps in the coordination
The report highlights how gaps in the coordination between hospitals, GPs, pharmacies, and community care providers are contributing to unsafe transitions. Discharge processes often fail to take into account the complexity and constraints of the local health and care system. This has resulted in follow-up actions not being carried out or completed within expected timeframes.
Key findings include documented cases of patient harm where critical follow-up actions were not undertaken due to poor discharge communication; a lack of interoperability between IT systems, leading to missed, delayed, or lost clinical information; discharge summaries not reaching all providers responsible for ongoing care, and sometimes not reaching patients themselves.
This was exacerbated by no clear accountability for the safety of patients in the early post-discharge period; a normalisation of poor-quality discharge communication, with limited regulatory oversight of cross-provider pathways; and insufficient education and training for clinical staff on how to write effective, user-centred discharge correspondence.
The investigation also found that electronic systems used to generate and send discharge summaries are often poorly designed or configured, increasing the potential for errors. In some cases, discharge summaries are generated and sent before care has concluded, meaning they contain outdated or inaccurate information.
Lack of integration
“The main issues stem from discharge planning not considering the organisation of the local health and care system, alongside a lack of integration – as evidenced by the limited collaboration between primary, community and secondary care – and IT systems not passing information seamlessly along,” said Woodier.
“These factors make continuity of care challenging. Staff we spoke to within the NHS have expressed that it is difficult and stressful to make decisions based on incomplete information, which hinders their ability to deliver the highest standard of care,” he continued.
The report contains two recommendations to the Department of Health and Social Care (DHSC).
The first is focused on providing standards to support access to high-quality safety-critical information that takes account of the complexity of local systems. The second is aimed at setting expectations for NHS healthcare providers to enable them to deliver continuity in patient care after discharge from hospital.
