125 ‘Better the letter’ – improving hospital discharge communication for palliative care patients: a service evaluation

Abstract

Background Communication between hospital and primary care at discharge is vital to ensure patients feel supported and prevent crisis readmissions. The hospital palliative care team (PCT) have developed comprehensive training for all doctors and produced ‘better the letter’guidance to improve discharge letter content. The most recent innovation is the inclusion of a specific palliative care section on discharge letters with key information for GPs around advance care planning. Methods A ‘snapshot’service evaluation was conducted from October to November 2018. Discharge letters were examined for patients discharged from hospital who were on the hospital PCT caseload. Discharge letters were examined for presence of a completed palliative care section and relevant GP actions. Electronic records were reviewed for suitable patients for the presence and content of an EPaCCS (electronic palliative care coordination system) record, created by the GP within two weeks of discharge. Results 166 discharged patients were identified and 151 of these patients had discharge letters available for evaluation and were included in the study. 74% of included patients had an active palliative care section on their discharge letter. EPaCCS could not be assessed for 51 of the 151 patients due to patient death following discharge. 60% of patients with an active palliative care section on the discharge letter had an active EPaCCS record versus 38% of patients without an active palliative care section. Conclusions There is some evidence that the presence of a specific palliative care section on discharge letters improves the creation of EPaCCS records in the community, which may improve the coordination of care for these patients. However, there was a proportion of missing data due to death soon after discharge. Further work is needed to improve communication of palliative care information on hospital discharge, and evaluation of the impact this has on patient care.