Audit of the Quality and Content of Discharge Summaries from Mental Health Inpatient Units across Betsi Cadwaladr University Health Board

We have noticed that the quality and content of discharge summaries can be quite poor. This is a potential patient safety risk, particularly as our patients often require early follow up and are discharged on potent medications. As a result of our audit, we hope to ensure that patients are safely followed up by the correct agencies, and the information is received in a timely manner.

Our aim was to carry out an audit of the discharge summaries sent from the 3 North Wales psychiatric inpatient units against recommendations from Standards for Inpatient Mental Health Services (RCPsych) and PRSB Mental Health Discharge guidelines.

The first audit cycle used 25 discharges from wards from each inpatient unit for the months of June-August 2018. Data was collected week commencing 16/09/18 using the audit proforma. Each individual discharge summary was scrutinised for the inclusion of appropriate headings. The 3 sites each have their own method of writing the summaries.

Hergest and Heddfan Units sent their summaries out to GP on of discharge in 100% of cases. Only 13% of Ablett summaries did the same.

Crisis contacts were not documented in a single summary throughout the 3 sites. Ablett Unit sent 49% of summaries to the GP with nothing more than medications documented. Automatic input of certain mandatory headings resulted in % fill rate.

We have identified an unacceptable delay in the GP receiving the Ablett discharge summaries in the majority of those sent. None of the 3 sites managed to include the majority of suggested headings in their summaries, resulting in poor quality.

We have identified a lack of time and poor attitudes as barriers to improvement, however, these are important documents and failure to complete could lead to catastrophic consequences for the patient, and the Health Board if faced with a significant event in the future.