Methods
In response to this critical GP feedback regarding inconsistent delivery and suboptimal quality of ED discharge summaries, SCH embarked on a collaborative project to improve communication deficiencies.
We engaged the GPLOs, ED clinicians and administration staff to analyse the ED communication challenge comprehensively. The CHOP-ED initiative prioritised expediting communication processes with primary care partners by leveraging off established and successful processes for the sending of outpatient correspondence and harnessing the transmission capability of our existing dispatch hub.
In partnership with the in- house Fluency for Transcription (FFT) support team we established an ED Administration Officer template which allowed ED Admin officers to copy and paste completed EDIS or FirstNet discharge letters into FFT which allows electronic transmission of letters to GPs using the dispatch hub.
A phased project rollout began in June 2023, commencing at the largest facility, Sunshine Coast University Hospital (SCUH), followed by Nambour General Hospital (NGH), Gympie and Caloundra Hospitals.
ED Admin Officers were trained in completing the FFT template correctly and copying and pasting the letter. At Gympie, this workflow initially based around the EDIS discharge letter but following the ieMR rollout at Gympie Hospital in October 2023 it easily transitioned to using the FirstNet letter.
In line with clinical practice, admin staff were entrusted with integrating clinically verified ED letters into the digital platform and appending an electronic signature (“eSignâ€) on behalf of clinicians. This protocol guaranteed swift access to ED letters for primary care providers and universal clinician access to these letters via The Viewer within one hour of eSign completion.
As part of CHOP-ED the 'ED Discharge letter" was renamed and redesigned as the 'ED Clinical Handover letter' which better reflected the nature of the letter in allowing primary care providers to receive a handover and continue patient care beyond the hospital.
The redesigned template followed consultation and feedback with GPs and our SCH based GPLOs.
The new fields that were included were:
- Presenting problem and major assessment findings in the ED
- Relevant pathology and imaging results in the ED (includes incidental findings requiring follow up)
- New and ceased medications
- Clinical handover plan
February 2025 saw the introduction of automatic pre-population of GP details from the HBCIS Patient Administration System (PAS) into the Fluency Flex letter templates, further streamlining the process.
A FirstNet Clinical Handover letter dashboard was developed to monitor the percentage of patients being discharged from ED Including STTA) whom had a clinical handover letter available for electronic sending at the time of discharge.
An existing SCH FFT activity dashboard was able to accurately capture the numbers of letters sent electronically by ED Admin Officers.
GP and GPLO feedback were gathered from a satisfaction survey, underscoring the initiative's positive impact on patient care continuity, potential for reduced hospital readmissions, and regard for health professionals
