Intended for healthcare professionals

Student Practical skills

How to write a discharge summary

BMJ 2015; 351 doi: https://doi.org/10.1136/sbmj.h2696 (Published 03 July 2015) Cite this as: BMJ 2015;351:h2696
  1. Elizabeth Stopford, senior house officer1,
  2. Sean Ninan, specialty training year 6 elderly medicine registrar2,
  3. Nick Spencer, fourth year medical student3
  1. 1Redland Hospital, Brisbane, Australia
  2. 2University of Leeds, UK
  3. 3Leeds General Infirmary, UK

How you can help improve the continuity of patient care

Writing discharge summaries is traditionally the task of junior doctors. They may have had formal or informal training about how to do this, but the quality and amount of training vary. Discharge summaries are too often seen as a lower priority for pressurised junior staff, who might not have had sufficient feedback and supervision in how to produce high quality summaries.

Problems with discharge summaries

The discharge summary should facilitate the safe transition of care from the hospital setting back into the community, delivering information that is both relevant and accurate to aid continuing care. However, errors with discharge summaries are common. In 2002 the Royal College of Physicians audited 149 case notes in five hospitals in England and Wales. Of 87 printed discharge summaries present in the notes, 17% contained no diagnosis, 19% had no procedure, 21% had no follow-up arrangements, and 75% provided the general practitioner (GP) with no information on what the patient had been told.1 Similar problems with accuracy and prescribing errors have been found in other studies.234

GPs are often unhappy with the legibility, timeliness, and accuracy of discharge summaries. In 2009, the Care Quality Commission reported that only 53% of GP practices said they received discharge summaries in time to be useful either “all” or “most” of the time.5 Only 27% of GP practices reported that discharge summaries were “hardly ever” or “never” inaccurate or incomplete, and 81% of practices reported that details of prescribed medicines were incomplete or inaccurate on discharge summaries “all” or “most” of the time. In one case reported by the NHS Alliance, a patient received a discharge summary 11 years late, although delays of three months to a year are more common.6

Barriers to quality

A discharge summary is a …

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