Discharge summaries, also known as 'TTOs' (To Take Out) or 'TTAs' (To Take Away), play a crucial role in facilitating the continuation of care for patients once they leave the hospital. As a Junior Doctor, it is essential to understand the significance of well-written discharge summaries and their impact on effective outpatient management. In this blog post, we will explore the key components of a discharge summary, discuss the importance of timely completion, and provide practical tips for streamlining the process.

Components of a Comprehensive Discharge Summary

When preparing a discharge summary, it is crucial to include the following information:

• Patient details: Full name, date of birth, and hospital number.

• Name of the Consultant overseeing the patient's care.

• Diagnosis: Clearly state the primary diagnosis or reason for the hospital admission.

• Important results: Summarise significant findings such as positive or negative test results, ECG changes, or scan results.

• Treatments given during the hospital stay.

• Specialist teams involved in the patient's care during their admission.

• Allied healthcare professionals: Mention if the patient received care from professionals such as dieticians, physiotherapists, occupational therapists, or social workers. Note any changes made to the patient's social setup in the community.

• Treatment plan on discharge: Describe the prescribed medications and any specific instructions for follow-up care.

• Follow-up arrangements: Provide details of outpatient appointments, follow-up procedures, or scans (also include dates and times whenever possible!).

• Patient communication: Mention important information conveyed to the patient regarding their condition, treatment, or post-discharge care.

• Your name and contact information for the ward - this is in case the patient/GP has any queries or if follow-up communication is needed.

Timely Completion of Discharge Summaries

Try completing the discharge summary in good time so that patients can be discharged without much of a delay. Consider the following:

• Obtain the GP's name and address from the patient, the front page of the notes, or the EPR early in the discharge process.

• Write the discharge summary as soon as possible to ensure timely retrieval of medications from the pharmacy. Ideally, complete the summary at least 24 hours in advance to prevent delays and inconveniences for both patients and healthcare staff.

• Some hospitals enforce a pre-11 a.m. discharge policy, requiring discharge summaries to be written 24 hours before the patient's departure. This policy streamlines the discharge process, frees up beds, and reduces bleeps from nurses seeking information - but the policy at your Trust may differ so always be sure to check!

• Writing discharge summaries in advance showcases efficiency and earns the respect of seniors and nurses. It also helps you manage fewer patients on the ward, providing better focus on those who require care.

• Double-check the prepared discharge summaries for any recent changes before signing them off on the day of discharge.

Practical Tips for Efficient Discharge Summary Completion

Consider these strategies to optimise the process:

• Paper system: Carry a supply of TTOs during ward rounds, allowing you to complete them promptly when a decision is made to discharge a patient.

• Electronic system: Conduct a quick mental review during ward rounds to ensure no outstanding issues exist.

• Contact the GP on discharge under certain circumstances (usually listed on the discharge summary under the section, “GP to perform.”). These circumstances could include self-discharge, unstable conditions, complex home circumstances or care needs, elderly/terminally ill patients, or the need for an early visit or repeat blood test after discharge.

Conclusion

Writing comprehensive and timely discharge summaries is a crucial responsibility for junior doctors. By including all relevant information, completing the summaries in advance, and maintaining effective communication with GPs, you contribute to seamless outpatient care and ensure a smooth transition for patients. Embrace these practices to become a more efficient and valued healthcare professional, promoting better patient outcomes and overall healthcare delivery.

by Dr Ahmed Kazie