Improving Documentation and Communication with Care Homes when Discharging Older Adults from ED.

Introduction:

This quality improvement project (QIP) was conducted in a busy Emergency Department (ED) in South Wales (Grange University Hospital (GUH)), as part of efforts to improve safety for older patients. Our ultimate goal is to reduce unnecessary re-admissions, as hospital stays can cause rapid deconditioning in older patients. Patients aged over 65 account for 25% of ED attendances (Emergency Care Data Set, 2024). It is well documented for this subset of patients that good handover is crucial to improving overall standards of care, and continuity of care into the community. Standard practise should be to inform the home of important investigations and treatments, and hospital follow up. Safety netting advice must also be given and documented. To ensure this, GUH ED introduced a standardised “Care Home Communication” document, to complete on discharge, however use has been limited. This QIP was undertaken to improve the use of the ‘Care Home Communication’ document.

Methods:

Each QIP cycle, we retrospectively reviewed notes from 50 patients who attended the ED from care or nursing homes, and were discharged directly. We assessed notes and formcompletion rate. After each cycle, changes were implemented such as introducing the forms at induction, and making them more accessible.

Results:

This year, 24% of patients had Care Home Communication forms in their discharge notes, an increase from 5% (2023) and 14% (2024). This shows a significant increase over the time period. Across all 3 cycles, there were additional patients with evidence of a verbal handover in the notes, but with no form completed, suggesting more work can be done.

Conclusions:

This QIP has shown that improvement is possible, however, more action is needed to increase uptake of the documentation. We propose adding a notification on the computer system that alerts clinicians and offers to print the form.