An investigation of written discharge communication between hospital clinicians, GPs, and patients in the UK

Background: Discharge letters are important for transferring information from the hospital to the GP. Patients are sometimes copied into these letters, but this is not standardised. Hence, many patients do not receive such letters, but the consequences of this remain unclear.

Research Aim: To describe why patients currently receive discharge letters (or not) and how different stakeholder groups think this process should take place to optimise patient experiences and outcomes.

Methods: The mixed methods design comprised four studies. Study 1 formed a realist review. Study 2 involved 53 GPs sampling and commenting on 489 discharge letters and GP interviews and focus groups. Letters were examined using content analysis. For study 3, patients to whom the sample letters related were interviewed (N=50). Interview and focus group data were analysed using corpus linguistics. For study 4, hospital professionals (N=46) who wrote the sample letters were surveyed and the data analysed using descriptive statistics. The studies were triangulated to build matched cases termed “quartets” which aligned the discharge letters with the viewpoints of the relating patients, GPs, and hospital professionals.

Findings: Participants across groups were generally in support of patients receiving discharge letters, although some expressed reservations. Many patients favoured receiving a direct copy of the GP letter. However, to increase clarity and usefulness, letters should be written in a form accessible to both GPs and patients (e.g. avoid acronyms). Additional key findings were: patient understanding is perhaps greater than clinicians perceive, clinician attitudes are a barrier to patients receiving letters, and that, negative outcomes more commonly manifested in contexts where patients had not received letters, rather than when they had. Conclusion: This thesis suggests several ways in which processes of written discharge communication may be improved. Patients should be offered a choice of discharge letter receipt and their preferences should be recorded.