More patients getting the rehabilitation they need after changes to discharge summaries

A revamped discharge summary that includes important information about rehabilitation needs is improving outcomes for patients discharged from Auckland City Hospital.

A small project team at Te Whatu Ora Te Toka Tumai Auckland identified that even small changes to the discharge summaries of people who were discharged from hospital with moderate to severe traumatic brain injury (TBI) could improve the process.

The team, led by Auckland City Hospital physiotherapy clinical lead Hannah Zuhir, has improved the discharge process by creating a space in the discharge summary for rehabilitation-specific information, which means it no longer gets forgotten or lost in the discharge process.

Before this project, allied health and rehabilitation information was hard to find and easy to miss because it was recorded throughout the clinical notes. The team created a dedicated space in the discharge summary and developed an allied health assessment form to keep this important information together.

‘A lot of patients are transferred back to a local hospital before specialist TBI rehabilitation,’ says Ms Zuhir.

‘Because the discharge information only included medical information, and their rehabilitation needs could be hard to find or missed completely, patients were sometimes discharged to a facility that couldn’t meet their ongoing rehabilitation needs.’

This could lead to delayed rehabilitation input, the risk of people not being followed up or not receiving the care they need, readmission to hospital and poorer outcomes.

Ms Zuhir says that adding a dedicated space for important rehabilitation information in the discharge summary means that patients are more likely to receive the follow-up care they need.

‘Our aim was that 90 percent of people with moderate to severe TBI being discharged or transferred from the neurosurgery wards at Auckland City Hospital would have a rehabilitation plan included in their discharge paperwork,’ she says.

‘Improving the handover of information at discharge means that rehabilitation providers get all of the information about the patient’s needs in a timely manner, and nothing is missed.’

They also developed and introduced a family and friends questionnaire, which gives the medical and allied health teams a comprehensive understanding of the patient’s background and cultural needs, factors that can play an important part in rehabilitation.

‘Developing a tool that was culturally safe was of huge importance to our team, so we engaged with patients and co-designed the questionnaire with help from a Māori health researcher,’ says Ms Zuhir.

‘Engaging with family and whānau gave us a better understanding of the role of whānau in the rehabilitation process. It was a really valuable learning process for the team.’

The questionnaire is now routinely sent to the provider along with the allied health summary and clinical discharge information.
Allied health input into discharge is now becoming integrated at Te Whatu Ora Te Toka Tumai Auckland and is included in house officer and allied health inductions.

‘We’re now trialling a template to make it straightforward to put this information in the discharge summary,’ says Ms Zuhir.

‘When we first started the project, 100 percent of patient discharges were sent with allied health input included, but this has been hard to sustain.’

‘Several factors were at play: the COVID-19 Omicron surge meant that staff sickness and case loads impacted our success. However, approximately 75 percent are still being discharged with this information complete, which we’re really pleased with.’

The integrated assessment form and family and friends questionnaire is being introduced to other wards within Auckland City Hospital.

‘The team is so proud of what we’ve achieved, and it’s great that our organisation can see the value in it and is helping us to increase the use of this tool across the hospital.’

This project was completed as part of a national collaborative focused on improving rehabilitation for patients with major trauma.

In 2021, the trauma rehabilitation national collaborative brought together 11 teams of rehabilitation clinicians from across Aotearoa New Zealand to complete quality improvement projects that would improve outcomes for patients’ rehabilitation after major trauma. The collaborative is part of a broader programme of work by the National Trauma Network, Accident Compensation Corporation (ACC) and the Health Quality & Safety Commission (the Commission) to establish a contemporary system of trauma care in Aotearoa New Zealand.

Find out more about the programme on the Commission’s website and read the full case study from Te Whatu Ora Te Toka Tumai Auckland below.