Rapid dispatch: how electronic discharge forms have improved care in Swindon

Creating electronic discharge forms can be a quick win for NHS trusts that want to improve their working practices and deliver better patient care, as Swindon and Marlborough trust has discovered.


Concerned that poor or late discharge summaries could compromise patient safety and continuity of care, Swindon and Marlborough trust and its commissioning primary care trusts (PCTs) set themselves a target to improve the patient discharge process.

The old way: on paper

A paper-based, manual process meant there was some potential for errors to occur; a problem made worse because the forms used were quite complex, with duplication of information. Even when completed, delivery of the discharge summary was not guaranteed.

It was not uncommon for a patient to be asked to present the summary to their GP at their next appointment or within a few days of leaving hospital. Unfortunately, in many cases the summary did not reach the GP. The summaries that did were hand-written, carbonised copies; with 50 per cent unreadable or missing vital information. "It was also an opportunity to look afresh at workflow, and to remove some of the processes and elements that were being duplicated, or perhaps were not needed on a discharge summary.”

Targeting a solution

The trust set a target that all discharge summaries should reach their destination within 48 hours of discharge, and worked with e-discharge specialist WCI Consulting to come up with a solution.

“Our key requirement was that the trust should have something that all users would be able to read accurately and that would be delivered promptly,” says Janet Waplington, healthcare marketing manager at WCI.

“This would help improve communication and continuity of care from secondary to primary care. It was also an opportunity to look afresh at workflow, and to remove some of the processes and elements that were being duplicated, or perhaps were not needed on a discharge summary.”

Using lean processes

First, WCI applied lean process design to identify all the steps in the discharge process and all the information being gathered. This was no simple feat, as the process could vary across the trust.

Once the information had been gathered, it was analysed to identify the most efficient workflow process and to see where steps were duplicated or no longer necessary.

This process was undertaken with the collaboration of stakeholders including administrative staff, pharmacists, clinical coders, clinicians, nursing staff and GPs. The trust and WCI agreed that it was vital to involve users to ensure engagement and the acceptance of proposed changes to current working processes.

The new way: e-discharge

WCI then developed an e-discharge application that hospital clinicians access through ward computers. An electronic discharge summary is created for each patient when they are admitted to hospital by a ward clerk.

The form is then accessed and updated with relevant clinical information regarding the patient’s admission prior to discharge. Once the patient is discharged, the form is submitted electronically - via a secure link - to their GP. "The trust and WCI agreed that it was vital to involve users to ensure engagement and the acceptance of proposed changes to current working processes."

The new application was developed using Microsoft Sharepoint Portal Server 2007 and InfoPath electronic forms. The information is extremely secure as the completed forms are stored in a secure part of the trust’s server and can only be accessed using a hyperlink emailed to authorised GP practice users.

The clinical coding team is also given access to the electronic discharge summary. Having the information available in an electronic form helps to make coding more accurate and much faster.

Involving stakeholders

The pilot and testing phase of the implementation took place in spring 2007 on a single ward at The Great Western Hospital in Swindon. Roll out to a further three wards quickly followed, with electronic discharge forms being provided to 48 GP practices across two PCTs, covering a population of over 300,000 people.

By the end of 2007, a total of 25 areas and wards inside the trust were creating timely electronic discharge summaries, giving patients and primary care providers a better continuity of care service.

Key stakeholders were also encouraged to be involved in the project at this stage and to provide feedback on the system’s design and application.

Visits were made to staff to discuss their requirements throughout the project and this was important in creating good engagement. The consultation also ensured that clinicians’ requirements were better met. For example, a decision was made to amend the form to provide clear information on drugs that had been stopped while a patient was in hospital, in response to requests from GPs. "The trust [is] creating timely electronic discharge summaries, giving patients and primary care providers a better continuity of care service."

Further developments: more automation

Further service improvements are now underway to provide additional automation and service to GPs. Discharge summary information will be automatically transmitted directly into GP practice systems via an encrypted, secure link.

This will enable GPs to go into their own patient systems and view the discharge summary together with all the other clinical information held about a particular patient.

More about WCI: More information about Microsoft gold partner WCI Consulting and its work in healthcare can be found on the WCI Group website. Here you can find more information about how Microsoft InfoPath can be used to improve discharge procedures and review the full case study with Swindon and Marlborough PCT.