Embedding Comprehensive Geriatric Assessment into Discharge Communication: A Completed Quality Improvement Project

Introduction

Comprehensive Geriatric Assessment (CGA) only delivers value if its findings survive the transition from hospital to community, and the discharge summary is the principal vehicle carrying CGA into primary care. In a pre-implementation staff survey (n=14), 86% reported medication changes and rationale frequently missing, and 86% reported incomplete summaries at least occasionally causing extra work or safety concerns.

Method

We completed a Trust-registered full audit cycle on two geriatric medicine wards at Ealing Hospital against BGS CGA Toolkit, RCP, AoMRC and NICE NG27 standards. Audit criteria mapped discharge documentation to CGA domains: diagnoses; functional status; premorbid social set-up; medication changes with rationale; allied health input; follow-up plans and GP actions; and ceilings-of-care and goals-of-care discussions. Thirty randomly sampled summaries were reviewed pre-intervention (October 2025) and thirty post-intervention (December 2025–January 2026), after a five-week two-component intervention: a structured EPR auto-text template (.DMOPDSUM) organised around these domains, and dedicated teaching covering CGA, discharge summary writing, sourcing each domain, and why every template section matters to primary care — repeated after rotation changeover.

Results

Documentation improved in every CGA domain: functional status 26.7% to 86.7%, premorbid social set-up 30.0% to 76.7%, follow-up plans 63.3% to 100%, actions for GP 56.7% to 96.7%, medication changes with rationale 56.7% to 86.7%, and allied health input 16.7% to 50.0%. Goals-of-care documentation improved modestly (16.7% to 23.3%), remaining the weakest domain. Documentation remains a proxy for communication quality, and gains depended on repeated teaching through changeover.

Conclusion

A CGA-structured template with education markedly improved communication of CGA findings across the care interface. Sustainability now requires system-level embedding rather than reliance on teaching: template training within induction; a mandatory ceilings-of-care and escalation prompt with a ’not applicable’ option; consultant reinforcement on ward rounds; annual structured GP feedback; and re-audit at 12 months targeting sustained ≥90% compliance.