Written medical discharge communication from an acute stroke service: a project to improve content through development of a structured stroke-specific template

Abstract

Specific guidelines for the content of discharge summaries from acute stroke services do not currently exist. The aims of this project were to assess the strengths and weaknesses of stroke discharge communication from Imperial College Healthcare NHS Trust, to develop a structured template to guide completion, and to re-audit discharge communication following its implementation. The audit compared local performance against record standards from the Academy of Medical Royal Colleges (1), which was augmented by criteria generated from the British Association of Stroke Physicians (BASP) Stroke Service Standards (2). Discharge information was examined within the Trust's Electronic Discharge Communication (EDC) system to determine the recording of selected items for consecutively discharged patients from the hyperacute and acute stroke units. The audit was repeated following implementation of a newly developed stroke-specific discharge summary template. Fifty-one EDC summaries were examined at baseline (July 2012) and 30 summaries at re-audit (January 2013). The criteria which showed low adherence initially and which showed the most significant improvement following the introduction of the template were the guidance on blood pressure and lipids targets (increased from 2% and 0% respectively at baseline, to 93% post intervention), and the driving and flying advice (from 3% to 79%). Documentation was also seen to improve for measures of physical and cognitive function, discharge arrangements, and follow up plans.This audit cycle has demonstrated improvement in the consistency of content within written discharge communication following the introduction of a structured stroke-specific template adhering to combined criteria from identified standards.