Objective: To examine the information contained in medical and nursing staff hospital discharge letters for stroke patients entering nursing home care.
Design: A retrospective content analysis comparing case notes with discharge letters.
Setting: Nottingham (UK) hospitals.
Subjects: Thirty-eight stroke patients with a Barthel Activities of Daily Living Index score of less than 11/20 at three months post stroke who were discharged into a nursing home.
Method: Patients' medical case notes and medical and nursing discharge letters were subjected to the same structured content analysis. The three key areas were: self-care ability (i.e. washing, dressing), nursing needs (i.e. diet, continence) and risk assessment (i.e. falls, pressure sores).
Results: Discharge letters were least likely to provide information on risk assessments, for example only 14 (37%) documented the risk of pressure sores and 7 (18%) falls. Thirty discharge letters (79%) had information relating to self-care ability and nursing care, although a blanket term ‘needs all care’ was used to describe patient ability in 20 (66%) of these.
Conclusion: The results demonstrate that the completeness and accuracy of information is often poor, doing little to enhance the continuity of care for patients who are transferred from hospital to nursing homes.
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References
1.
Rudd AG, Irwin P, Lowe D, Wade D, Morris R, Pearson MG. The national sentinel audit for stroke: a tool for raising standards of care. J R Coll Physicians1999; 33: 460–464.
2.
Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M. Comprehensive discharge planning for hospitalized elderly: randomized clinical trial. Ann Intern Med1994; 120: 999–1006.
3.
Parfrey SP, Gardner E, Vavasour H et al. The feasibility and efficacy of early discharge planning initiated by the admitting department in two acute care hospitals. Clin Invest Med1994; 17: 88–96.
4.
Weinberger M, Oddone EZ, Henderson WG. Does increased access to primary care reduce hospital readmissions?N Engl J Med1996; 334: 1441–1447.
5.
Kumlien S, Axelsson K, Ljunggren G, Winblad B. Stroke patients ready for discharge from acute care – a multi-dimensional assessment of functions and further care. Disabil Rehabil1999; 21: 31–38.
6.
Bowling, A. Research methods in health. Buckingham: Open University Press, 1997.
7.
Leith BA. Patients' and family members' perceptions of transfer from intensive care. Heart Lung1999; 28: 210–218.
8.
Sackley CM, Gatt J, Walker M. The use of rehabilitation services by private nursing homes in Nottingham. Proceedings of the Society for Research in Rehabilitation, Winter 2000. Clin Rehabil2000; 14: 454-454.
9.
van Walraven C, Weinberg AL. Quality assessment of a discharge summary system. Can Med Assoc1995; 152: 1437–1442.
