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Quest to improve quality of electronic discharge advice letters from acute Geriatric Medicine wards

I am a consultant geriatrician in Glan Clwyd Hospital and the Clinical Director for Care of the Elderly (COTE) & Community Hospitals for the Central Area Team.

Our QI project involved improving the quality of electronic Discharge Advice Letters (DAL) when patients are discharged from the COTE wards. With the enthusiastic participation of some of the junior doctors in the COTE department, we initially carried out an audit of 40 DALs in 2018 to assess accuracy and quality on various domains of the DAL format (presenting complaints; investigation results; progress in hospital; diagnostic list; advice and recommendations to the GPs). The results demonstrated inadequate quality of information in most of the domains. Actions for change included induction training on quality of DALs to junior doctors, regular education sessions and reinforcement on quality and circulation of a simple aid de memoir on how to complete a good quality DAL to the junior doctors via social media and emails. A repeat audit after 8 months showed a significant improvement in quality in most of the domains.

The project won the Medical Director for Education award for Best Trainee Poster at the BCUQI Conference in April 2019.

The next steps would be to maintain the momentum and undertake similar QI work in other medical and non-medical specialties and raise awareness on the importance of good quality discharge summaries amongst junior and senior doctors across the hospital.

The IQT silver training that I completed in 2018 was an eye-opener on how to identify, scope and scale a good IQ project through a robust discussion with all the stakeholders, identifying the aims through process mapping and driver diagrams and thinking of the types of measures and how to bring about the changes. I would strongly recommend others looking to start a QI project to avail the QI training opportunities to get a clear insight on how to engage in a realistic QI project capable of delivering change leading to an improvement.

Dr Indrajit Chatterjee (Chattopadhyay): Consultant Physician

Department of Geriatric Medicine; Glan Clwyd Hospital; Rhyl

Acknowledgement: I am deeply indebted to the following junior doctors who contributed to this project: Anupama Nair (Specialty Doctor); Jong Eun Song (Foundation Trainee); Nibu Thomas (Specialty Trainee); Shumaila Asif (SHO); Mehwish Mussarat (SHO); Glan Clwyd Hospital, Rhyl.

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