Imperial College Hospital Trust –
New Discharge Summary Submissions & Clinical documentation
OVERVIEW
Imperial College Hospital Trust discovered that, due to issues and limitations with their existing EPR system, not all letters issued to GPs were received. Since they did not have a robust monitoring and reporting mechanism in place, the trust could not establish the scale of the problem, nor identify the specific instances where discharge summaries were not received by GPs.
Discharge is a complex process, involving multiple internal and external system components working together; EPR, HL7 Messaging (Integration Engine) and downstream systems, for example. The setup can vary across NHS trusts, so our first priority was understanding the local configuration and workflows. We also didn’t know how many patients had been affected, which made a new reporting mechanism an urgent requirement. Root cause analysis was also a crucial part of this deliverable.
INCREASE IN
SUCCESSFUL GP
DISCHARGE
SUMMARY
SUBMISSIONS”
Our review revealed that the failure in sending discharge letters was due to an issue in the existing hard-coded functionality within the trust’s EPR system. The ‘Discharge Patient and Send Letter to GP’ (Submit to GP) button was not highlighted as a mandatory field, meaning that users could easily bypass this pivotal step in the process. This created a number of significant risks, potentially impacting patient safety and continuity of care as well as financial aspects.
Because of limitations within the system design, the trust had been advised by Oracle Cerner (previously Cerner Corporation) that this particular button could not be mandated. ICHNT were therefore looking for an alternative solution to ensure that the Submit to GP step could not be circumvented.
As part of our initial analysis, we also discovered many occurrences where staff were not using the correct workflow to discharge the patient (e.g. discharging patients via the PAS discharge conversation in Person Management office instead of using the Depart functionality within Powerchart). Users needed to be restricted from performing the wrong workflow. In addition, there were no reminders or alerts set up in the system to prompt clinicians to complete the discharge summary.
- Significant increase in successful GP discharge summary submissions
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More efficient process for clinicians to document the discharge process
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New functionality to auto-trigger failed discharge summaries on the next scheduled run
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Mitigate clinical risks with a more robust process for managing discharge summary submissions
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New security solution implemented to ensure that clinical staff submit to GP upon completion of the depart process
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New monitoring and auditing tool to maintain and track GP discharge summary submissions
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Multiple reports available covering all main scenarios where a discharge summary may not be submitted (e.g. form complete – not submitted, form saved – not signed nor submitted)
SOLUTION
We anticipate that our approach will increase the discharge summary submission success rate by tightening up the workflow logic and incorporating new system alerts, ensuring that users follow the correct process. Our optimisation of the discharge functionality included the following components:
New alert prompt: upon completion of the last mandatory section in the discharge process, a new system alert prompts clinical staff to sign the form ‘If depart complete and ready to be sent to GP’. Staff will be made aware that ‘Submit to GP’ must be selected following this message.
New alert configured on the PAS discharge conversation to redirect staff to the discharge process if this is incomplete.
New discharge form launched directly from the above alert, prompting clinical staff to specify whether discharge is complete (Yes/No). If ‘No’ is selected, a reason must be given.
Alerts configured to reoccur each time patient records and/or encounter is opened in PowerChart, again prompting the user to complete the discharge process.
Logic incorporated for subsequent alerts to stop, once discharge is complete for a given patient record.
Depart declaration: mandatory statement by clinical staff upon completion of discharge. This action is automatically recorded in the database for auditing purposes.
Custom DA2 Reports: multiple reports to monitor and track non-submitted discharge summaries.