Improving documentation of Comprehensive Geriatric Assessment in a new electronic patient record system across care settings

Introduction:
In October 2023, the electronic patient record system Epic® was introduced across two London NHS Foundation Trusts — King's College Hospital (KCH) and Guy's & St Thomas' (GSTT). This replaced legacy documentation processes, including the Comprehensive Geriatric Assessment (CGA). At KCH, a CGA template widely used by the multidisciplinary team was lost, leading to inconsistent CGA documentation, poor communication of outcomes at discharge, and reduced data usability. This quality improvement project aimed to standardise CGA documentation and communication across care settings.

Methods:
A cross-site working group was formed including IT colleagues focused on Epic® optimisation. Key CGA domains and standard descriptors were agreed. New 'SmartPhrases' were created to present CGA findings clearly and these embedded into a redesigned discharge summary template. The Epic® CGA Navigator tab was rebuilt to support streamlined, structured data entry, enabling automatic population of discharge documents. Implementation was supported by departmental teaching and integration into ward rounds on a pilot ward at each Trust. Pre-intervention, a random sample of discharge summaries from geriatric wards was assessed for inclusion and clarity of CGA domains; post-intervention, discharge summaries from pilot wards were analysed.

Results:
Pre-intervention, discharge summaries included an average of one CGA domain. Post-intervention, this increased to average five domains at KCH and four at GSTT. At least seven domains were included in 26% (10/38) and 16% (5/32) of discharge summaries at KCH and GSTT, respectively. Clarity improved from 11% (10/89) to 47% (18/38) at KCH, and 27% (41/153) to 56% (18/32) at GSTT.

Conclusion: This cross-site initiative improved CGA documentation and communication, enhancing clarity and consistency of discharge information. There has been an evolution in phraseology, particularly around the domains included within a CGA. Getting hospital-wide CGA will be an important enabler in frailty-attuned care across acute and community settings.