From Zero to Hero, the rise of the Trauma and Orthopaedic discharge summary

• DOI: 10.1136/bmjquality.u201983.w1029
• Publication Date: 2013-10-14T19:55:49Z
• Authors: Jonathan Evans; Alexander Armstrong
• Keywords: 03 medical and health sciences; 0302 clinical medicine; BMJ Quality Improvement Programme; 0206 medical engineering; 02 engineering and technology; 3. Good health

AbstractDischarge summaries document key information after an in-patient care episode and hand back care to the GP. Locally our orthopaedic department used carbon-copy paper as a discharge document. Anecdotally, these were thought to be inaccurate, illegible and of poor quality. Complaints from GPs became a catalyst in assessing the accuracy and presenting it to the department.A baseline dataset of inaccuracies was collected. This became a good starting point to develop a new improved system of discharging orthopaedic patients. We proposed to develop a bespoke, electronic, patient centred discharge document. Our aims were to improve patient safety, quality and develop an adaptable document, which could be updated to be in line with local CQUINs. The initial challenges of the resistance to change within the department were overcome by presenting data in an open forum with an agreed trial period.A multidisciplinary team was formed, including managers, consultants, junior doctors, allied health professionals and IT personnel. This facilitated live decision making, streamlining the processes. We created an adaptable online document, which enabled regular updates. This in-turn improved the overall accuracy of the document, improved prescription of key medications and ensured we were able to fulfil local CQUINs. We highly recommend the use of subspecialty specific electronic discharge summaries.