Patients are being put at risk when leaving hospital due to serious failures in how clinical information is electronically shared with community nursing teams, a new report has warned.
Community nurses are often missing “vital information” about diagnoses, medications, and follow-up care, leading to delays or errors in treatment, according to the Health Services Safety Investigations Body (HSSIB).
“Our report is specifically calling for stronger oversight and accountability to ensure critical information is reliably communicated”
Nick Woodier
The arm’s length government body today (10 July) published a report into the risks associated with the electronic discharge summary – the main tool for transferring clinical information from hospitals to primary and community care.
Discharge summaries, which may be completed by nurse practitioners, resident doctors or physician associates, are typically sent to community nursing teams after a patient is discharged from hospital.
However, the HSSIB investigation found “several incidents” in which community nursing teams did not receive a discharge summary at all after a patient had left hospital.
In other cases, nurses said they were not automatically sent summaries, making it difficult to know how to clinically care for patients post-discharge.
One series incident revealed that a community nurse gave a patient insulin after they had left hospital, unaware that the patient’s insulin regimen had changed.
The patient became unresponsive and had to be readmitted. It was later found that no discharge correspondence had been produced about the change.
Community nursing teams told the HSSIB that information needed to inform ongoing care was sometimes missing.
They said discharge summaries should include more information about “what was normal for the patient” at discharge, such as vital sign measurements.
Both nurses and GPs told the investigation that, if there had been critical changes in information that affected a patient’s ongoing care, this needed explicit communication.
The report also found that electronic systems used to generate and send discharge summaries were often poorly designed or configured, increasing the potential for errors.
In some cases, discharge summaries were generated and sent before a patient’s care had concluded, meaning they contained outdated or inaccurate information.
Everyone who contributed to the HSSIB investigation recognised the risks posed by poor discharge communication.
Issues with creating and processing correspondence were described as “significant”, “long lasting” and “unresolved”, with some warning associated risks had become “normalised” and underappreciated.
The HSSIB made two safety recommendations, targeted at NHS England and the Department of Health and Social Care (DHSC).
The first was to develop and validate new discharge correspondence templates for primary and community care settings.
The second was to set specific expectations for NHS providers to ensure safety-critical information about patients is accessible after discharge.
Nick Woodier, senior safety investigator at HSSIB, said staff reported that it was “difficult and stressful” to make decisions “based on incomplete information”.
He said this “hinders their ability to deliver the highest standard of care”.
Mr Woodier added: “The main issues stem from discharge planning not considering the organisation of the local health and care system, alongside a lack of integration – as evidenced by the limited collaboration between primary, community and secondary care – and IT systems not passing information seamlessly along.
“These factors make continuity of care challenging.”
The report comes as the government last week published its 10 Year Health Plan, which pledged to move NHS care from analogue to digital.
Mr Woodier said: “The recent publication of the 10 Year Plan emphasises how important it is to ensure digital systems and electronic communications are invested in and fit for future delivery.
“Our report is specifically calling for stronger oversight and accountability to ensure critical information is reliably communicated, supporting a safe discharge process for patients needing vital follow up care.”
DHSC and NHS England were contacted for comment.
More on the 10 Year Health Plan
