N van Sluisveld

National Institute for Health and Clinical Excellence (NICE)

English

D Bendel

H Gardner

M Outram

Crossref

POSTER PRESENTATION Open AccessWritten communication for itu discharges: a qualityimprovement projectD Bendel*, H Gardner, M OutramFrom ESICM LIVES 2015Berlin, Germany. 3-7 October 2015IntroductionITU patients are complex, and detailed written handoverin the form of a discharge letter plays a central role inpatient safety [1]. We sought to characterise and improveupon the quality of our written handover on discharge.ObjectivesTo improve the quality of written discharge communi-cation.MethodsIn 2014, we audited our discharge summaries over a twomonth period. Our adopted standards were the NationalInstitute of Health and Clinical Excellence (NICE) clini-cal guidelines 50 and 83 [2],[3]. They detail variousdomains that should be present on a summary. Thesedomains formed the basis of our audit proforma.Discharge summaries were then scored according towhether the domains were satisfied or not. The totalscore for each domain was then divided by the totalnumber of discharge summaries, in order to indicate thepercentage of summaries that satisfied each domain.Following this audit, we introduced an electronic dis-charge summary template. The template is composed ofmandatory headings that cannot be deleted. Each headingaddresses a different domain from NICE guidance, and isNorthampton General Hospital, Department of Anaesthesia and Critical Care,Northampton, United KingdomFigure 1 Detail of the new discharge summary.Bendel et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A143http://www.icm-experimental.com/content/3/S1/A143© 2015 Bendel et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal work is properly cited.followed by a free-text box. They contain suggestions ingrey that disappear upon entering information (Figure 1).We closed the audit loop in 2015.ResultsOur discharge summaries fell short of our adopted stan-dards across several domains. Frequent omissions includedlegal aspects such as patient demographics (10%), Dr’s des-ignation (8%) and bleep number (68%). Other regularlyomitted domains included a plain-English summary forrelatives (18%), relevant investigations (35%) and a planfor patient monitoring on return to the ward (45%).This was due, at least in part, to the document’s ‘free-text’ nature.On re-audit, the legal aspects of our summaries arealmost 100% compliant. There is improvement to areassuch as reason for admission (99%) and diagnosis (85%).New information that now features on our summariesincludes pending investigations, nutrition plan, infectionstatus, limitations of treatment and information for rela-tives (figure 2).Our new discharge template has dramatically improvedthe quality of our written handovers.ConclusionsThe safe handover of ITU patients relies on detailed writ-ten communication, in line with NICE guidance. Simpletechnological interventions such as the discharge templatedescribed here are an effective way of achieving this.Published: 1 October 2015References1. van Sluisveld N, Hesselink G, van der Hoeven JG, Westert G, Wollersheim H,Zegers M: Improving clinical handover between intensive care unit andgeneral ward professionals at intensive care unit discharge. Intensive CareMedicine 2015, 41(4):589-604.2. National Institute for Health and Clinical Excellence (NICE): CG50 Acutely illpatients in hospital: NICE guideline. London: NICE; 2007.3. National Institute for Health and Clinical Excellence (NICE): CG83 CriticalIllness Rehabilitation: NICE Guideline. London: National Institute for Healthand Clinical Excellence; 2009.doi:10.1186/2197-425X-3-S1-A143Cite this article as: Bendel et al.: Written communication for itudischarges: a quality improvement project. Intensive Care MedicineExperimental 2015 3(Suppl 1):A143.Figure 2 Areas of significant improvementBendel et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A143http://www.icm-experimental.com/content/3/S1/A143Page 2 of 2

Intensive Care Medicine Experimental

Written communication for itu discharges: a quality improvement project

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Written communication for itu discharges: a quality improvement project

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