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The Discharge Communication Study: An investigation of written discharge communication between hospital clinicians, GPs, and patients

“…it [discharge] is done so wrong and there are sooo many areas for improvement” Patient participant

Discharge letters are important for communicating information between clinicians. Patients sometimes receive these letters but sometimes they do not. Discharge communication practices may vary across specialties, hospitals, Trusts and geographical regions. The discharge communication study sought to examine and explore different practices and experiences in order to generate suggestions for how discharge communication processes may be improved. The study had two main focus points: patients receiving letters and the content and quality of discharge letters.

53 GPs from 18 GP practices within the West Midlands selected recent discharge letters (total=489) for the study. 26 of these GPs took part in interviews and focus groups which explored their views on discharge communication and how improvements may be made. All patients to whom the letters related were invited to take part in interviews to discuss their recent discharge experience and 50 choose to participate. Hospital professionals who wrote or signed the letter were invited to take part in a survey on their views on the letter they wrote and how current processes may be improved. 46 hospital professionals returned completed surveys. Data were analysed using methods from health sciences and applied linguistics to include content analysis, corpus linguistics, and statistical analysis. Study results were triangulated to map specific discharge letters to the corresponding perspectives of those involved. These grouped cases were termed “quartets” and aimed to illuminate agreements and disagreements between experiences and any reasons why.

The study found that despite guidelines, patients receive discharge letters inconsistently and discharge letter quality issues remain. Participants across groups generally supported patients receiving letters. To increase letter usefulness and improve clarity, letters should be written in a way that is accessible to both GPs and patients (e.g. no unexplained acronyms) and prioritise components important to recipients (e.g. clear and appropriate GP actions).

Ethics approval was granted by the UK Health Research Authority (HRA) in July 2017 (IRAS ID: 219871, REC reference: 17/WM/0170, sponsor: University of Warwick). 

Doctoral Researcher

Katharine Weetman

Supervisors

Professor Jeremy Dale (UAPC, Warwick Medical School)

Dr Emma Scott (UAPC, Warwick Medical School)

Dr Stephanie Schnurr (Applied Linguistics, Social Sciences)

Collaborators

West Midlands CRN

Funding

This work was supported by the Economic and Social Research Council (ESRC) grant number ES/J500203/1 and Clinical Commissioning Groups (CCGs) of Coventry & Rugby and South Warwickshire

Dates

October 2015 to November 2019