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Patient Oriented Discharge Summary (PODS) could promote selfcare in older patients

16 September 2020

Hospital discharge forms are written with care professionals in mind. While this is understandable, it can leave the patients themselves confused about the treatments they have received, and what the next steps are. The patients may be unaware of what conditions they have, the results of investigations and the medication required following hospital discharge. They also need to know what they can do to help themselves and where to go to receive ongoing help.

A Patient Oriented Discharge Summary (PODS) intervention is likely to benefit all patients but this study focused on the older population as high users of the NHS services generally and who experience greater numbers of hospital admissions for both for acute and chronic conditions.

Dr Marion Steiner, a GP at the Southmead and Henley Family Practice in Bristol, was looking to find a more patient-friendly discharge form, and with the help of the Research for Health Award from the Elizabeth Blackwell Institute, she teamed up with Dr Alyson Huntley of the Centre of Academic Primary Care at the University of Bristol.

Previous research

Their aim was to use an existing PODS, developed by the University Health Network of Toronto, Canada, to see if this approach is appropriate and acceptable to older people and health professionals in a UK healthcare setting.

Dr Huntley explained: “We conducted a review of the evidence around support for older patients at the time of hospital discharge. We established a focus group with older patients who have experienced hospital care and interviewed health professionals who are involved in the process within North Bristol NHS Trust.”

She continued, “There is limited but promising evidence from the literature for the use of a PODS interventions to have the potential to influence readmissions, attendance at outpatients and primary care use as well as helping patients in a variety of ways, such as their preparedness for discharge, and enhancing quality of life.”

Patients’ and health professionals’ views

The group’s findings suggest that discharge summaries are written in such a way as to alienate older patients. As they are aimed primarily at care professionals, they contain significant amounts of abbreviations and jargon. Any current patient-friendly information on the forms is limited and highly variable, as the forms are often produced in a hurry and not necessarily by the most appropriate health professional. The focus group suggested a PODS would be welcomed by older patients who consider practical information a priority.

“It’s a balance,” explained Dr Huntley. “The health care professionals we interviewed suggested that, if patient-friendly information is included in a discharge summary, it still needs to contain the essential and potentially complex medical information for ongoing care, such as medication detail. Even with the best efforts of all concerned, patients are not always able to take the information in during a hospital stay. But patients said that they wanted clear instructions (‘do and do not’) and that being able to understand signs and symptoms better could be lifesaving.  They were also keen to know who to contact if they had concerns following a hospital stay, wanting a real person on the end of the phone.

"The other potential issue we identified is that production of a PODS intervention is challenged by data protection and a dearth of clear communication channels within the hospital and between hospital and community care computer systems.

“Both older patients and healthcare professionals think that the current hospital discharge summaries are lacking - and they would welcome more patient-friendly content.”

From here, the team is planning on using the data and the team building expertise they acquired to apply for bigger projects.

In depth assessment

Dr Steiner said, “Whilst the frail elderly may be a complex group to study, they have in depth multidisciplinary assessments whilst they are in hospital, and this information currently does not usually leave hospital with the patient. It would be useful to compare outcomes with a fit, generally healthy cohort, such as people undergoing elective surgery."

"The foundations have been laid for further research, involving interested patients, clinicians and hospital trust management. The next step is to recruit another centre and apply for funding to develop and trial a new form, potentially with different cohorts of patients.”

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