What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Hospital readmissions are linked with poor quality discharge summaries and inequities. Poor quality refers to under-completion, errors, incomprehensibility, and poorly designed formats which are problematic for GPs and patients in the short-term, and for hospital staff in the longer-term through avoidable readmissions. 76% of Care Opinion stories that comment on discharge summaries are complaints, with evidence that errors cause harm and additionally create inefficiencies through generating unnecessary work to right the wrongs.  Elsewhere, evidence suggests that patients do not realise that discharge summaries could even have a function for them. A resilient system relies on processes that enable anticipation and timely adaptive responsiveness, and this is particularly important at hospital discharge.  We aim to identify the key principles for good discharge summaries, to support patients and families to safely and efficiently navigate the early post-discharge period, and thereafter bring this as an improvement approach to a hospital ward.

What does your project aim to achieve?

We aim to identify the key resilience-based, patient and family derived principles of a good discharge summary and to work with a hospital ward to deliver these for sustainable change to reduce inefficiencies (reducing unnecessary work), and to avoid harm (through errors).  This will be achieved in two key phases. Working with local community groups (supporting those disproportionately affected by healthcare safety inequities) we will explore comprehensibility, usefulness, and suggestions for improvements (based on a resilience framework that includes system-level recommendations) with a selection of redacted discharge summaries. In phase 2 working with one hospital ward, we will explore the barriers and opportunities using the capabilities-opportunities-motivation behaviour change approach to integrating the discharge summary principles into practice and develop a quality improvement project to initiate and evaluate the changes. Our evaluation will include a sample of patients who have recently been discharged.

How will the project be delivered?

Our team includes a research nurse and a research AHP who have extensive knowledge of patient safety research and the hospital to home discharge period. They have experience in conducting focus groups and analysing qualitative data.  We will involve the local Voluntary Care Sector Alliance (with whom we already have a relationship) who cover 4,000 organisations to identify appropriate community groups and our budget and timeline allows for appropriate renumeration, the community support needed to build trusting relationships with these groups and providing essential feedback. We have included within our budget support from the Improvement Academy to develop and evaluate the quality improvement initiative. This work has capacity for scaling up to inform a larger piece of work leading to national recommendations that will include general practitioners and community allied healthcare professionals.

How is your project going to share learning?

We are extensively networked to share the learning and to explore opportunities for scaling up from this study. We are part of the Yorkshire and Humber Patient Safety Research Collaboration (PSRC) who are addressing patient safety concerns of strategic importance including safety inequities. We are the co-ordinating centre for all six PSRCs represented under an umbrella SafetyNet with direct links to policy.  We have links across the ICBs into their research communities of practice with representation on our executive board from WY ICB. Our Y&H PSRC Advisory board includes international expertise on care transitions so future opportunities for international collaboration are likely.  We will share our findings across Y&H Applied Research Collaboration who have a keen interest in older people (one of our target groups) and care transitions and the Improvement Academy.