Improving e-discharge summaries learning resource:

guidance for trainees

Introduction:
Junior doctors, physician associates, advanced clinical practitioners and other healthcare professionals
authoring discharge summaries have historically had little training on how to write good discharge
summaries and may receive no feedback or supervision for the task; the methodology and resources
available for writing discharge summaries may vary both between and within Trusts.

To achieve accuracy and consistency in discharge summaries the HIU has now created an education
resource which aims to improve the understanding of the importance of comprehensive, accurate
summaries, and explain how this can be achieved. This guidance document has been written to accompany
the resource.

These instructions are provided for trainees who are opting to carry out the learning activity independently,
or as part of a small group, unsupervised. However, you are strongly encouraged to discuss the activity and
your experience of it with your educational supervisor. The activity should take 1-2 hours. For those
completing the training as part of a supervised group, the supervisor of the activity will have instructions to
lead the activity.

Resource toolkit contents list:

1. ‘Discharge summary template overview’ (PDF)
A generic discharge summary template aligned with the PRSB e-discharge summary standard. This
is not intended to be a definitive template but includes the main clinical headings for educational
purposes to help people to write a quality discharge summary.
2. ‘Discharge summary template crib sheet’ (PDF)
Notes to guide writing a discharge summary.
3. ‘Discharge summary template and annotated example’ (Excel)
An example patient discharge summary annotated to explain points of importance.
4. ‘Activity-Clinical notes example’ (PDF)
Example clinical notes to accompany the discharge summary writing task, in PDF format for ease of
printing, if desired.
5. ‘Activity-practice discharge summary writing task’ (Excel)
Example clinical notes with accompanying blank discharge summary, with relevant fields pre-
populated.
6. ‘Activity-practice discharge summary example completion’
Example completion of a discharge summary for the example clinical notes provided.
7. ‘E-discharge summary self-assessment checklist’

Project manager: Lindsay Dytham

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 Self-assessment checklist to enable self- or peer-review and guided reflection of the completed
practice discharge summary (4-6 above).
8. ‘Guidance for supervisor - e-discharge summary learning resource’
Guidance notes for supervisors of the e-discharge summary learning resource (this document).
9. ‘Guidance for trainees -discharge summary learning resource’
Instructions for trainees completing the e-discharge summary learning activity independently
(without supervision).
10. Audit tool to assess the quality of an e-discharge summary. Available online:
https://www.rcpworkforce.com/se/253122AC0ECAF952

Learning activity instructions:

Pre-activity audit
If you are currently authoring e-discharge summaries, it is suggested that you review the standard of these
prior to delivering the learning activity. Audit materials have been prepared as part of this resource pack
(see link below) to enable an audit both before and after the learning activity to assess the impact of the
learning activity on the quality of your discharge summaries. The act of conducting this review, in itself, will
also act as an important part of your learning regarding what is important about a discharge summary as a
communication tool. You can repeat this as many times as you like, with multiple summaries, to give you a
clear measure of quality.

Trainee doctors are required to undertake quality improvement projects, including audits, and may be able
to use this review as evidence for part of this requirement.

The audit tool is available here: https://www.rcpworkforce.com/se/253122AC0ECAF952

Learning activity
1. Review and critique the example discharge summary provided (see ‘3. Discharge summary
template and annotated example’). Click through each cell to see annotations of strong and weak
points in this example. This exercise also introduces the generic example template (see ‘1.
Discharge summary template overview’, as well as highlighting the importance of good written
documentation.

2. Complete a discharge summary for an example patient using the clinical notes provided (see
‘4. Activity-Clinical notes example’ and ‘5. Activity-practice discharge summary writing task’). You
may wish to use the ‘crib sheet’ as guidance material at this point (see ‘2. Discharge summary
template crib sheet’ and Figure 1a and 1b below) to help write the summary.

3. The completed discharge summary should be either peer- or self-assessed using the checklist (see
‘7. E-discharge summary self-assessment checklist’).

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 4. Compare your completed discharge summary to the completed example provided to consider areas
where you could make improvements (see ‘6. Activity-practice discharge summary example
completion’).

5. Discuss your experience of the activity with your educational supervisor. Specific additional training
may then be required, which your supervisor should direct you towards. You may wish to repeat
this learning activity periodically throughout your training.

After the learning activity

Two-four weeks after carrying out the learning activity, review at least one real discharge summary you
have written, using the audit tool: (https://www.rcpworkforce.com/se/253122AC0ECAF952). As before,
you can repeat this for multiple e-discharge summaries you have written, to give a more reliable measure
of quality.

For F1 doctors, you could consider completing a case-based discussion (WPBA) by writing a real discharge
summary for one of your patients on the Trust’s system in your Foundation portfolio, with the focus on
written communication. Reflect on the elements you have included, based on the learning activity, that you
may have otherwise neglected.

You are encouraged to re-visit the learning resource materials at regular intervals to provide a reminder of
the learning and to keep striving to improve your completion of e-discharge summaries.

Summary of instructions

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 1.
Figure 1a: Crib sheet – part 1
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Figure 1b- Crib sheet – part 2

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