A patient-orientated hospital discharge summary to promote self-care in older patients: a mixed-method study to determine suitability and outcome measures
Patients who are discharged following a stay in hospital are often not well informed on the treatments they have received whilst in hospital and the next steps for their care. This is in part because conventional hospital discharge forms are devised with the health professional in mind. Patients may be unaware of results of investigations, diagnosis, medication, what they can do to support their health, and where to seek ongoing help. Our aim was to determine whether a patient-orientated hospital discharge summary (PODS) developed to promote self-care is appropriate and acceptable to older people and relevant care professionals in the NHS setting.
We conducted a rapid review of the evidence for PODS interventions. In addition, we conducted a focus group with older patients recruited from general practice and interviews with relevant health-care professionals within North Bristol NHS Trust. Our outcomes were a) a recommendation on the implementation of a PODS intervention b) A set of meaningful outcomes for its evaluation c) Understanding of the practical steps needed to facilitate its implementation.
There is limited but promising evidence from the literature for the use of a PODS intervention to have the potential to influence readmissions, attendance at outpatients and primary care as well as influencing patient outcomes e.g. preparedness for discharge, quality of life. A focus group with patients and qualitative interviews with health-care professionals indicate that conventional discharge summaries are written in complex language with jargon and abbreviations, and that a patient friendly discharge summary would be welcome. They are often produced in a hurry and any patient friendly content is generally limited and variable. Health-care professionals suggest if patient friendly information is produced it needs to be enough not to give the wrong message but that some information is technical e.g. medication detail and that even with the best effort’s patients are not always in the situation to take the information in. Patients articulated that they wanted clear instructions (‘do and do not’) and that understanding signs and symptoms better could be life saver. Production of a modified discharge summary is challenged by patient data protection and a lack of ‘connectedness’ within secondary care and between secondary care and primary/community care IT systems.
These data suggest that both older patients and health-care professionals consider present hospital discharge summaries to be lacking and welcome more patient-friendly content. Whilst the evidence is limited it appears to be of value to support a primary study into the feasibility of a PODS intervention for the older patient and its impact on both patient wellbeing via selfcare and health-care service use.