- Smart Healthcare, Wednesday 18 November 2009 09.00 GMT
When my mate Bill left hospital after his prostate operation last month, he was presented with a discharge summary. This took the form of a lengthy proforma, which had boxes for recording all the readings taken during the operation and afterwards. Bill was a bit puzzled because "not recorded" was written in nearly all these boxes. The result was that the discharge summary did little more than announce that he had had the operation.
I was rather shocked by this. Clearly, the summary form had been designed to carry a lot of meaningful information, but the doctors had just not bothered to enter it. This was a particular shame in Bill's case, because he had never been in hospital before, and this discharge summary could have been the foundation stone for his patient record.
I find that I am not the only person to be worried about inadequate discharge summaries. I read a few days later that a body called the Care Quality Commission has written a report, which says that 81% of GPs found that "information shared between GPs and hospitals when a patient moves between services is often patchy, incomplete and not shared quickly enough". The GPs' main grumble (from 53% of those responding) was that they didn't receive discharge summaries in time for them to be useful, despite a national target for April 2010 for all summaries to be sent within 24 hours.
Bill's hospital at least achieved that target, and thereby wins brownie points, but ignores the need for the discharge summaries to be meaningful. I can imagine the consultants receiving the news that they had to achieve a 24 hour target, and exploding "all right then, we'll give them their summaries within 24 hours, but they can't expect us to record anything useful in such a ridiculously short time".
Quite right, they can't, if they use the traditional method of hand-writing the discharge: sending it to Bangalore with all the other outpatients' reports for transcription, correcting all the mistakes on its return to the UK and stuffing the typed results in the strike-bound Royal Mail.
But there are other ways, like voice recognition, which would make meeting the 24 hour target a doddle. But I understand from suppliers of such systems that persuading doctors to change their hallowed working practices to adopt voice response is like drawing teeth. The CQC "advocates the roll-out of an IT system, suitable for sharing more information in an effective way". And now they say it!
Delving further, I find that in 2007 and again in 2008, the NHS Alliance wrote horrified reports about the same thing, and that also last year, the Royal College of Physicians and Connecting for Health were cooperating to develop standards for documentation. I am glad to hear it, but shocked – although not very surprised – that their efforts have not yet percolated down to the hospitals and GPs after two years.
I sometimes think that the NHS is made up of various bodies, like the Care Quality Commission, the NHS Alliance and the Royal College of Physicians, who seldom talk to each other. They have each suddenly realised – years after it has become all too glaringly obvious to humble patients like me – that hospitals do not communicate properly with GPs. They produce reports saying that the situation is dire and something must be done. But where is the drive to push solutions through together? Not from what is laughingly called "Connecting for Health", that's for sure.
Meanwhile, according to the CQC, only 53% of GPs get the summaries in time for the first follow-up appointment. Let's face it: producing timely or accurate records is not high among most hospital doctors' priorities.
