10 FYi • Advice


BEFORE YOU GO…


All foundation doctors have to fill out discharge forms for patients leaving hospital. Dr Naeem Nazem offers advice on getting this vital task right


T


HE life of a foundation year doctor is by no means a quiet one. Whether you are clerking new patients, providing ward cover or managing your own team’s patients, the list of tasks to get done can seem endless. One inevitable – and very important – job for all


foundation year doctors is completing the discharge form.


Whether your hospital uses an electronic system or remains with the more traditional hand-written form, most patients will need a completed discharge form before they leave the hospital. You may be approached to complete discharge forms for patients at


the end of a registrar or consultant-led ward round. Or you may be bleeped to be told that one of your patients is now fit for discharge. Perhaps the most disheartening situation is when you are on-call covering the wards and receive a bleep asking you to complete one (or often more) discharge forms for patients you have either never met or know very little about.


Bottom of the pile? Foundation doctors quickly realise the necessity of prioritising their work based on clinical need. In most occasions it is simply not possible to complete jobs the moment you are given them. You may feel that patients needing discharge forms are fit to leave hospital and so they can wait until you have addressed the clinical needs of sick patients. Although no one could argue with your logic, patients and their families are often desperate to leave hospital as soon as they have been given the green light. It is therefore very helpful to inform ward staff at an early stage if you are swamped and won’t be able to complete a discharge form so that they can manage the patient’s expectations. Some doctors take a different view. They consider discharge forms as


“quick jobs” and are keen to clear them out of the way to make their task list more manageable. You may attend a ward to find several forms waiting for you and feel the urge to blitz through them at the same time


as you re-write the endless prescription charts that have run out. There is some rationale to this approach – it will certainly enable ward staff to turnaround the bed more quickly, making it available for the next patient.


Think differently Whenever you feel the urge to hastily complete a discharge form it is worthwhile taking a moment to consider what happens once the patient leaves the relative safety of the hospital premises. From feedback we have received at MDDUS from GPs, the discharge form is often the only piece of information they have on the patient’s hospital care and treatment. You may have commenced some medicines and stopped others, or asked the GP to monitor or follow-up an outstanding issue. In the absence of a complete discharge form, a patient’s GP can only rely on the patient’s recollection of events, which we all know can often be very poor.


The extra few minutes you take to complete a discharge summary


thoroughly can make a huge difference to the patient’s care after they leave your hospital. Unfortunately, GPs are under as much time pressure as hospital doctors and therefore often do not have the time to call hospitals to find out what treatment their patients received. It is therefore all the more important that their colleagues in secondary care provide them with all the relevant information they need to continue a patient’s care in the community. The GMC also provides guidance to doctors in their core guidance Good medical practice (2014) which states at paragraph 44 that doctors “must contribute to the safe transfer of patients between healthcare providers … you must share all relevant information with colleagues involved with your patients’ care”.


Dual benefits When you complete and sign a discharge form, even if it is for a patient you don’t know that well, you are acting as the hospital representative


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