- Design
- Retrospective record review, seven practices
- Population
- 263 patients aged ≥65 discharged from hospital
- Primary outcome
- Errors and harms linked to discharge actions; 90-day readmission
- Effect
- Error in 20.6% and harm in 4.4% of patients needing action; 17.5% related readmission
A BJGP retrospective study reviewed the records of 263 patients aged 65 or over discharged from hospital to seven general practices in the West Midlands over a year.
160 discharge summaries contained 551 requested actions — medication changes, blood tests, referrals, reviews. Of patients who needed an action, 20.6% experienced an error, usually an action not completed, and 4.4% came to harm. Most harms led to readmission; three of eight were judged preventable in primary care. 17.5% had a related readmission within 90 days. Errors and harm were concentrated in patients with dementia or a recorded carer.
The discharge summary is often treated as information to file. This study suggests it is a list of tasks, and the practice's system for processing it is a safety process.
The sample was small and from one region, but the pattern will be familiar. A named person, a defined timescale and a check that actions are done are low-cost fixes.
- Treat each discharge summary as a task list and assign a named clinician to action it
- Set a timescale for completing requested blood tests, medication changes and reviews
- Prioritise discharges of patients with dementia or a carer, who were most at risk
- Reconcile the medication list against the discharge summary at the first contact
- Audit a sample of recent discharges to see whether requested actions were completed
Why it matters
Errors after discharge often happen in the practice, not the hospital.
Don't overread it
Seven practices and 263 patients: the rates are estimates, not national figures.
The statistics, in plain English
The readmission estimate of 17.5% has an interval of 13.7% to 23.0%, reflecting the small sample. Error and harm rates apply only to patients whose summaries requested an action.
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