Box 3. Recommendations for safer processing of discharge summaries
Discharge summary design
  • Standardised structure

  • ‘GP action' box

  • Alphabetisation of medications listing

  • Highlight changed medication (for example by using standard codes)

  • Do not allow ‘hand annotations’

Primary care administration team
  • On-the-day workflow system for electronic documents

  • Priority scanning for paper discharge summaries

  • Priority flag discharge summaries within the electronic mailbox

  • Protected time and workspace for administrators involved in processing discharge summaries

  • Aim for usual or referring GP to process the discharge summary unless this will lead to potentially hazardous delay

Primary care clinical team (or trained administrative personnel)
  • Prioritise higher-risk patients and/or carers to contact for medications reconciliation

  • Consider making free-text entries about clinical decisions taken after reading the discharge summary (this could be recorded at the place where the discharge summary document can be seen in the facing electronic record)

  • Consider using a clinical pharmacist to assist with medicines reconciliation

  • Use IT to track actions; for example, electronic tasks, coded actions, diary functions

  • Protected time and workspace for GPs and other colleagues involved in taking action in relation to requests in discharge summaries

Wider systems redesign
  • Enable visualisation of discharge summary and electronic health record at same time (split screen or two screens)

  • Consider creating a template or consultation style in the electronic record (where possible, Read coded) to process the discharge summary; for example, data-entry points for diagnosis, significant test results, medication changes, discussions with patients and/or carers, and outstanding actions

  • Interoperability of primary and secondary care IT systems to allow for co-creation of the discharge summary. GPs would be able to comment on medication changes and requests for action prior to the patient being discharged