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Piloting the HIU learning resource for writing e-discharge summaries

In September 2018, Stephanie Johnson, advanced nurse practitioner (ANP) in acute medicine at the Royal Blackburn Hospital, took part in a pilot of a new learning resource to support all authors of e-discharge summaries in completing this important task. Stephanie explains what motivated her to be involved and what she took away from the training.

Completing e-discharge summaries is a crucial task for all junior doctors and advanced nurses to complete as part of their day-to-day work in acute medicine. Due to the fast pace of the environment and the demand to discharge patients in a timely manner, discharge summaries are not always completed to a high standard; even sometimes left for quieter periods within the day.

Crucial aspects of e-discharge summaries as occasionally missed, for example: medication changes, GP actions and recommendations, and details of the patient’s clinical history. Without any formal training provided by the hospitals trust or university when studying, it became apparent there was no standardised practice.

Clinicians aren’t given much opportunity to consider the purpose of the discharge summary as a key communication tool, or to appreciate its broad audience and what the various recipients need to use it effectively. With the pressures mentioned above, clinicians are often not sufficiently supported to be able to prioritise what to include within a discharge summary and how to write with the right level of detail. 

Discharge summaries are a daily priority, and due to the increased influx of patients within our ambulatory emergency care unit and the acute medical units, action was required to ensure patients had an accurate and appropriate discharge summary.

What I learnt from the training

By attending the RCP training it increased my awareness that there is actually no formal training given in relation to nurse/doctor education for writing discharge summaries. The training session helped me to identify the requirements that are essential for discharge summaries and also highlighted the important details to consider in order for other healthcare professionals to benefit from reading the summary.

In my organisation, the training was delivered as a multiprofessional group session, with junior doctors, nurses, pharmacists and physician associates. The face-to-face session changed my perception and awareness of writing these summaries, increasing my knowledge and consciousness to identify clinical findings required to share with the multidisciplinary team. Also, clarification regarding the use of medical jargon and abbreviations were explored, allowing us, as the trainees, to acknowledge that some healthcare professionals won’t use and understand each other’s specialist jargon. 

The most useful part of the training was the implementation of the discharge summary self-assessment checklist, which was given as a paper copy; it allows self-checking of summaries written and identifying which certain parts are necessary for each patient’s summary. The checklist allows for improvement and refection on how accurate discharge summaries are written. I believe this checklist will be useful to display within clinical environments as a prompt for clinicians completing discharge summaries. 

I would say my practice has improved since completing this training. It allowed me to self-check my summaries against the checklist and the PRSB standard. The training also made me more self-aware of who was reading the summary and how useful the summary can be for future interventions and admissions if completed correctly, with the right amount of information provided.

I have personally revisited the training with some of our trainee ANP colleagues and will certainly advocate any further training if required in the trust.

Stephanie Johnson, advanced nurse practitioner, acute medicine, Royal Blackburn Hospital, East Lancashire Hospital NHS Trust