Electronic Patient Discharge Promises Better After Care For Stroke Sufferers

A pioneering new way of collecting vital clinical information on stroke patients during hospital visits is being piloted by a Manchester hospital to enable GPs to provide better levels of ongoing care.

Manchester Royal Infirmary, part of Central Manchester and Manchester Children’s University Hospitals NHS Trust, is the first hospital in the country to use standardised electronic templates to gather comprehensive clinical information during hospital stays. It then sends the data electronically to GPs on the day of discharge.

The development comes in the wake of recent calls for better services for stroke sufferers from both the Stroke Association and the Healthcare Commission who said the care and rehabilitation of stroke patients outside hospital must be improved.

Designed by clinical correspondence specialists Medisec Software, the system uses a detailed stroke patient template developed jointly by Consultant Stroke Physician Dr Ganesh Subramanian and Dr Helen Hosker, General Practitioner with Special Interest, Older People’s Service Development at Central Manchester PCT.

The electronic discharge summary becomes a live document from the moment the patient is admitted to hospital. The information includes a detailed diagnosis of the type and severity of stroke, the results of all tests carried out during the admission, medication at the time of discharge, a description of the effects of the stroke in terms of disability, input from therapists, details of follow up arrangements and investigations and an overview of risk factors such as diabetes, hypertension, dietary habits and general lifestyle.

Dr Ganesh Subramanian commented: “Stroke patients tend to suffer from multiple health problems and complications, so healthcare professionals and GPs need as much detailed information about them as possible to offer the best quality of care. We’ve developed the most comprehensive template possible to make sure that GPs get the right information; the Medisec software then makes sure they get it in the right format and at the right time.”

The electronic notes are sent on discharge to the relevant GP via Medisec Net, which already delivers other clinical correspondence generated by the hospital to GPs using NHS Net. They are pre-tagged with Read codes to help GPs and their staff to input the information into their practice computer systems more easily and accurately.

The new electronic format overcomes many of the problems encountered with standard NHS discharge notification information, as Dr Hosker explains. “In the past, the immediate discharge summaries have been written in haste on multi-layered carbon paper and have frequently been illegible. The information they contained was very basic at best and virtually nothing or inaccurate at worst. We have taken over the care of patients who have had a major illness with minimal information – it’s been a totally unsatisfactory state of affairs for a long time for both GPs and patients.

“The more detailed discharge notes which we get from the consultant often don’t arrive until weeks, and sometimes even months, after the patient has been discharged, and often it is a case of too little too late. The electronic template system provides us with all the information we need to enable us to provide high quality ongoing care for our patients. It also provides the details we need for the patient’s medical record and for our contract – which is used as a measure of the quality of care we provide for our patients.”

She continued: “Until now, discharge summaries up have been a very variable feast, with hospital doctors telling us what they think we should know. This project has given general practice the opportunity to say what we need and to ensure standards are consistently high. Having the computer codes included throughout the document allows doctors to delegate the computer inputting work to other members of the practice team.”

Tom Rothwell, managing director of system designers Medisec Software, added: “Communication delays between primary and secondary care remain one of the biggest headaches facing the NHS today. The Trust already uses Medisec software to generate and issue electronic clinic attendance and discharge notification letters to GPs – plugging the information gap on discharge notification forms was the next logical step.”

The system mandates hospital staff to fill in all the compulsory fields – the software will not allow users to progress with the discharge form unless all the boxes have been completed. Dr Subramanian comments: “Because it’s been developed in collaboration with all the parties concerned, the extra effort involved in completing the template has not been called into question by clinicians – there is a taciturn recognition that it’s worth an extra couple of minutes for the massive improvements in the quality of data provided – and the positive impact on patient care in the wider community. And the templates are so highly structured, it’s actually very easy to navigate your way through.”

Dr Hosker added: “We are responsible for the ongoing monitoring of our patients for risk factors such as smoking, alcohol and exercise to reduce the risk of further strokes and other events such as heart attacks, but it’s very difficult to monitor such behaviour factors unless we have accurate information about them in the first place.”

Dr Alison Hutton, GP at Mount Road Surgery, Gorton and Chair of Manchester Local Medical Committee, has commended the improvements in the discharge summary that have accompanied the introduction of Medisec. “GPs will be delighted to receive the new Medisec discharge forms. This should prompt other specialities to do the same.”

The Trust is now hoping to extend the successful trials to other departments, including cardiology, ophthalmics and diabetes.

Notes to Editors

1. Medisec NET software provides electronic links between Manchester Royal Infirmary, Saint Mary’s Hospital for Women & Children, Manchester Royal Eye Hospital, University Dental Hospital of Manchester, Booth Hall and Royal Manchester Children’s Hospitals and GPs within central and south Manchester.

2. Medisec Software is a specialist systems developer providing clinical correspondence solutions for the health service.

3. The company is unique in supplying the UK’s only two-way communications package, allowing primary and secondary care professionals to exchange better quality patient information, more quickly and efficiently.

4. Medisec products generate patient information documents and communicate them electronically between hospitals, GP surgeries and other health agencies, such as social services.

5. 1,400 healthcare professionals use Medisec products nationwide, with over one million documents generated and transmitted using the software annually.

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