Cheshire first to find collaborative cure for NHS discharge communications headache

Long delays between a patient leaving hospital and their GP receiving detailed discharge notes have been an enduring bugbear for the NHS.

Now three Cheshire hospital trusts have signed up to a unique shared communications solution which builds on existing systems at the hospital and the GP surgery, giving the time-saving efficiencies of electronic delivery, without major IT investment.

By providing an interface which supplies access to faster, electronic delivery, the system is helping Acute Services to meet the new 24-hour service standards for discharge communications delivery and improving patient care.

Too little information, too late

As is standard across the NHS, the 92 GP practices across Cheshire received discharge notification forms and letters in different guises: as physical post, as email or in other electronic formats.

The initial carbon copy discharge updates were often difficult to read and contained only the most basic patient information. The formal discharge summaries from the consultant often did not arrive until weeks, sometimes months, after the patient had been discharged, too late to be of any real use for patient care.  GPs were often obliged to take over the care of vulnerable patients with limited details.

Dealing with the different forms of correspondence also put a huge administrative burden on surgeries, with practices spending several hours every week gathering, scanning, reconciling and filing each piece of patient information.

Low cost electronic solution

Fifty out of 54 surgeries across Central and East Cheshire now receive all their discharge correspondence from Leighton and Macclesfield hospitals electronically in one single in-box every morning. All 38 practices in West Cheshire also receive discharge letters from the Countess of Chester using the same MedisecNET electronic system.  Each surgery will eventually receive all clinical correspondence from all three hospitals in the same way.

As MedisecNET can collect from any hospital and deliver to any GP system, hospitals printing and posting correspondence can still plug into the electronic delivery network and speed up delivery times dramatically, without having to invest in a major IT overhaul.  This heralds a major opportunity for the NHS.

Diane Nolder, Senior IT Project Manager at Mid Cheshire Hospitals NHS Foundation Trust comments:
“Despite using a different system to generate our discharge correspondence than the two other Trusts in the area, we’ve still been able to plug into the same delivery network as them, producing a commonality of approach for GPs.”

GP practices can pay for MedisecNET on a rental basis so there is no large capital outlay.

Measurable outcomes

The system provides a clear audit trail from letter generation to delivery, so both the PCT and hospital can see exactly how long it takes to deliver discharge updates to GPs.

Patricia Reilly, IM&T Clinical Systems Manager, the Countess of Chester Hospital NHS Foundation Trust, explains:
“We can now compare how long it’s taking different specialties to generate and issue clinical correspondence.  By identifying backlogs and areas where action is needed, we can improve communications and deliver better patient care.”

With the right patient discharge information at the right time, GPs can better look after the needs of patients.

Dr Neil Paul, a GP at Ashfields Primary Care Centre in Sandbach, enthuses:
“Medisec is the missing link.  By providing one central electronic funnel which a whole range of providers can drop information into, it allows everyone to talk to one another in a consistent way.  We get critical clinical information from the hospital overnight rather than it sitting in out-trays, waiting to be printed or being lost in the post!”

He continues: “The NHS has been crying out for a solution to the illegible, flimsy, carbon copy discharge summaries GPs have to contend with when looking after the needs of high risk patients.”

Surgery staff can transfer the information into their practice systems without scanning or dual keying – saving time and avoiding errors.

“Before, surgery staff would waste hours scanning hundreds of documents each week,” claims Dr Paul. “Now, because each piece of correspondence is tagged with key data such as patient name, NHS number and specialty, it’s very quick for our staff to authorise and file letters.”

Better quality information

The electronic Discharge Notification Form (eDNF) developed by Leighton Hospital contains mandatory fields, providing GPs with the most comprehensive information possible.

Diane Nolder explains: “Populating the eDNF is quick and accurate with drop down menus and a full drug database.  Test results can also be added into the notes at the touch of a button.  We’ve worked closely with GPs to produce a template which gives them all the clinical information they need.”

The PCT can monitor service levels remotely to ensure continuity of service and react quickly to delays.

Debi Lees, ICT Project Manager/Business Analyst, Cheshire ICT Service, Central and Eastern Cheshire PCT, explains:
“If a hospital manually posts100 letters to a GP and only 87 are received, the practice would not know about the missing 13 letters.  The Medisec system automatically highlights any problems, so I can see at a glance if any letters (for technical reasons) haven’t been delivered.

“Our end game is for every surgery in Cheshire to receive all clinical correspondence, not just discharge forms, in the same way.”