Improvement Of Discharge Summaries in Orthopaedics and Orthogeriatrics Perioperative Patients

Introduction: 

Accurate discharge summaries are essential for ensuring continuity of care, particularly for frail orthopaedic patients. High-quality discharge communication has been associated with reduced post-discharge adverse events, medication errors, and hospital readmissions, while improving patient understanding of management plans. Following feedback from general practitioners regarding incomplete discharge summaries, we undertook this quality improvement project to evaluate the quality of orthopaedic discharge summaries and identify areas requiring improvement to support safe transitions from hospital to community care.

Methods: 

Data were collected over a six-month period (November 2025-May 2026) to capture discharge summaries completed by resident doctors across multiple rotations. Sixty patients were randomly selected using an automated randomisation tool. Discharge summaries were assessed against Royal College of Physicians discharge summary standards. Data collected included documentation of primary and secondary diagnoses, past medical history, investigations, medication changes and rationale (including bone protection plans), orthopaedic and orthogeriatric follow-up plans, outstanding scans, and weight-bearing status in accordance with British Orthopaedic Association guidance.

Results: 

Sixty discharge summaries were reviewed. Primary diagnoses were documented in 98% of cases. However, secondary diagnoses were incomplete in 67% of summaries, most commonly omitting delirium and acute kidney injury. Past medical history was incomplete or only partially documented in 35% and 32% of cases, respectively. Investigations were omitted in 77% of discharge summaries. Medication documentation was incomplete in 72% of cases, predominantly due to missing information regarding bone protection medication, including whether treatment had been initiated or reasons for omission. Follow-up plans were incomplete in 45% of cases, frequently lacking documentation of bone protection follow-up, outstanding scans, and weight-bearing status.

Conclusion: 

Orthopaedic discharge summaries frequently omitted key information, particularly relating to orthogeriatric management and bone health. We implemented targeted educational interventions, including multidisciplinary teaching sessions, a discharge summary checklist poster, and induction teaching for incoming resident doctors. Re-audit will assess whether these interventions improve documentation quality and compliance with national standards.