Electronic exchange of discharge summaries between hospital and municipal care from health personnel's perspectives

<p><strong>Introduction</strong>: Information and communication technologies (ICT) are seen as potentially powerful tools that may promote integration of care across organisational boundaries. Here we present findings from a study of a Norwegian project where an electronic interdisciplinary discharge summary was implemented to improve communication and information exchange between the municipal care service and the associated hospital.<br /><strong>Objective</strong>: To investigate the implications of introduction and use of the electronic discharge summary for health staff, and relate it to the potential for promoting integration of care across the hospital-municipality boundary. <br /><strong>Methods</strong>: We conducted semi-structured interviews with 49 health care providers. The material was analysed using a three-step process to identify the main themes and categories. <br /><strong>Findings</strong>: The study showed that the electronic discharge summary contributed to changes in health staff's work processes as well as increased legibility of summaries, and enabled municipal care staff to be better prepared for receiving patients, even though the information content mostly remained unaltered and was not always accurate.<br /><strong>Conclusion</strong>: Introduction of electronic discharge summaries did not result in a significant increase in integration of care. However, the project was a catalyst for the collaborating participants to address their interaction from new perspectives.</p

Hospital discharge: What are the problems, information needs and objectives of community pharmacists? A mixed method approach

After hospital discharge, community pharmacists are often the first health care professionals the discharged patient encounters. They reconcile and dispense prescribed medicines and provide pharmaceutical care. Compared to the roles of general practitioners, the pharmacists' needs to perform these tasks are not well known.; This study aims to a) Identify community pharmacists' current problems and roles at hospital discharge, b) Assess their information needs, specifically the availability and usefulness of information, and c) Gain insight into pharmacists' objectives and ideas for discharge optimisation.; A focus group was conducted with a sample of six community pharmacists from different Swiss regions. Based on these qualitative results, a nationwide online-questionnaire was sent to 1348 Swiss pharmacies.; The focus group participants were concerned about their extensive workload with discharge prescriptions and about gaps in therapy. They emphasised the importance of more extensive information transfer. This applied especially to medication changes, unclear prescriptions, and information about a patient's care. Participants identified treatment continuity as a main objective when it comes to discharge optimisation. There were 194 questionnaires returned (response rate 14.4%). The majority of respondents reported to fulfil their role as defined by the Joint-FIP/WHO Guideline on Good Pharmacy Practice (rather) badly. They reported many unavailable but useful information items, like therapy changes, allergies, specifications for "off-label" medication use or contact information. Information should be delivered in a structured way, but no clear preference for one particular transfer method was found. Pharmacists requested this information in order to improve treatment continuity and patient safety, and to be able to provide better pharmaceutical care services.; Surveyed Swiss community pharmacists rarely receive sufficient information along with discharge prescriptions, although it would be needed for medication reconciliation. According to the pharmacist's opinions, appropriate pharmaceutical care is therefore impeded

Promoting Clinical Engagement and Cross-sector Collaboration Through Changes in Workforce, Use of Technology, and Improved Business Systems

Published version made available here with permission from publisher.Background: Cross-sectoral collaboration across health care settings has the potential to deliver efficiencies as well as improve health care outcomes. There is a need for better understanding and awareness of models, mechanisms and strategies that enhance crosssectoral collaboration in Australia. Improved cross-sectoral collaboration is supported by a number of changes in workforce, use of technology and improved business systems. This review seeks to summarise these programs for those who may be seeking to engage in this area as a means of determining the range of options and possible proven benefits. Methodology: This study employs a mixed methods approach. A pragmatic literature review was undertaken to determine the relevant collaborative care models and review current programs Australia-wide that implement these models. Programs were selected from searching the grey and indexed medical literature as well as suggestions obtained from relevant stakeholders. Criteria for inclusion included having description in the peer reviewed and grey literature, ability to represent a unique model, extent of current use and description of outcomes of the intervention. Additional qualitative semi-structured interviews were conducted to elucidate more detailed information about technology, workforce and business systems. This information is summarised in the report and details about the individual programs are included as an appendix to this report. Results: Fifteen models were reviewed for this report. Qualitative semi-structured interview data were employed to supplement findings from the literature review. Key mechanisms of these models are described specifically focusing on the use of technology, workforce and business systems. Facilitators and barriers were identified and explored

Assessing the impact of evidence summaries in library and information practice

Objective This study developed, validated and administered an instrument to investigate the impact of research evidence summaries published in the journal, Evidence Based Library and Information Practice. Methods Using the critical incident technique, this mixed methods study began by developing and testing a survey questionnaire, disseminating it to readers of the journal and conducting follow-up interviews with a subsample. Findings A total of 86 practitioners responded to the survey and 13 took part in interviews. Evidence summaries led to impact at four levels: librarian knowledge, librarian practice, workplace practice, and library users. The instrument was revised as a result of the findings. Conclusion This study provides unique insight into whether evidence summaries are an effective means of bridging the research-practice gap for the library community and its scholarly communication channels. The validated impact assessment instrument may also be adapted for other means of disseminating research in library and information practice

Medication Reconciliation: Protecting the Geriatric Population

This project was designed to address the issue of medication errors that occur during the transition from an acute care setting to an assisted living setting. Geriatric adults are often supported by a complement of medical specialists and subspecialists. As a result, reconciling medications following a hospital discharge can be challenging. To further complicate the problem, oftentimes, the primary care provider is not highly engaged with the specialists and subspecialists. The World Health Organization (WHO) has prioritized this issue through the introduction of the Medication Without Harm initiative. This initiative is focused on reducing adverse drug reactions (ADRs) and adverse drug events (ADEs) resulting from improper reconciliation during transitions of care. In an effort to reduce the risk of medication-related harm to the geriatric population residing in an assisted living environment, this project presents a standard operating procedure (SOP) with supporting documents and tools designed to identify medication discrepancies resulting from transitions in care. This is supplemented with a specific communication tool for primary care providers to assist in the clarification and reconciliation of transitional medication orders

Evaluation of the pharmacist role in discharge from hospital

When patients are discharged from hospital it is vital that the information regarding their medication is provided to the General Practitioner (GP) as accurately and efficiently as possible. However errors frequently occur and the NHS is currently investigating how to improve discharge systems, one approach is to use pharmacists to write discharge prescriptions or To Take Out (TTOs). The aim of the audit was to compare discrepancies on TTOs (To take out) between different transcribers: doctors, pharmacists and nurses and identify factors which are predictors of discharge discrepancies. Discharge summaries written by different transcriber groups from three study wards at one hospital were selected. Discrepancies were identified by comparing the unauthorised TTO (TTO prior to final pharmacy check) to authorised TTOs, medical notes and prescription chart. Discrepancies were classified according to the CHUMS classification procedure. Logistic regression was used to identify predictors of discrepancies. Two hundred and fifteen TTOs were included in the audit written by pharmacists, doctors and nurses (n= 85, 81 and 49, respectively). Nearly 50% of TTOs contained at least one discrepancy, the most common of which was omission of a medicine. The significant predictors of discrepancies were if a TTO was written by a nurse or a doctor or if there was more than three hours between an unauthorised TTO being authorised (Odds ratios were 3.45, 2.26 and 3.88, respectively). Overall this study demonstrates the using pharmacist transcribers is at least as safe as previous systems and is unlikely to introduce additional discrepancies. Alternative approaches which support the healthcare team to work closer together at the time of discharge should reduce delays authorising the TTO and reduce discrepancies

Exploration of care continuity during the hospital discharge process

Background Communication regarding medicines at hospital discharge via discharge summaries is notoriously poor and negatively impacts on patient care. With the process being dependant on the quality of patient records during admission, junior doctors who write them and General Practitioners (GPs) who receive them, the objectives of this thesis were, with respect to discharge summaries, to:- assess their timeliness, accuracy and quality describe GP preferences explore experiences of junior doctors regarding their preparation. Methods Discharge summaries produced from one district general hospital were audited, as was the impact of changing the format of inpatient drug charts. A combination of observation, think-aloud and ethnographic interviews were conducted to investigate experiences of junior hospital doctors preparing summaries. A survey of GPs and junior doctors was undertaken to compare attitudes towards the discharge process. A pilot Discrete Choice Experiment (DCE) was developed and undertaken with GPs to determine their preferences with respect to the format, quality and timing of discharge summaries. Results A large proportion of discharge summaries were found to be inaccurate, however this was reduced when checked by a pharmacist. Key barriers to summary preparation identified were lack of time, training and knowledge of the patient. GPs perceived medicine changes on discharge summaries to be more important than did junior doctors. The DCE found that GPs were willing to trade timeliness of discharge summaries with accuracy. Discussion and conclusions The error rate within discharge summaries highlights the importance of a pharmacy accuracy check. The national requirement to deliver discharge summaries within 24 hours of discharge results in the pharmacist being bypassed and places additional pressure on junior doctors to prepare them in a timely manner, which might provide explanation for poor quality. Interestingly, GPs were willing to forego receipt of discharge summaries within 24 hours in preference for a reduced error rate. Keywords: patient discharge, discharge summary, patient transfer, interdisciplinary communication, medication errors

Cohort study protocol of the Brazilian collaborative research network on COVID-19 : strengthening WHO global data

Introduction: with the COVID-19 pandemic, hospitals in low-income countries were faced with a triple challenge. First, a large number of patients required hospitalisation because of the infection’s more severe symptoms. Second, there was a lack of systematic and broad testing policies for early identification of cases. Third, there were weaknesses in the integration of information systems, which led to the need to search for available information from the hospital information systems. Accordingly, it is also important to state that relevant aspects of COVID-19’s natural history had not yet been fully clarified. The aim of this research protocol is to present the strategies of a Brazilian network of hospitals to perform systematised data collection on COVID-19 through the WHO platform. Methods and analysis: this is a multicentre project among Brazilian hospitals to provide data on COVID-19 through the WHO global platform, which integrates patient care information from different countries. From October 2020 to March 2021, a committee worked on defining a flowchart for this platform, specifying the variables of interest, data extraction standardisation and analysis. Ethics and dissemination: this protocol was approved by the Research Ethics Committee (CEP) of the Research Coordinating Center of Brazil (CEP of the Hospital Nossa Senhora da Conceicao), on 29 January 2021, under approval No. 4.515.519 and by the National Research Ethics Commission (CONEP), on 5 February 2021, under approval No. 4.526.456. The project results will be explained in WHO reports and published in international peer-reviewed journals, and summaries will be provided to the funders of the study