Improving communication on discharge after acute stroke – a quality improvement project

<h3>Background</h3> Following acute stroke, long-term secondary prevention is typically the responsibility of primary care. However, discharge summaries communicating with GPs are normally completed by junior doctors often lacking expertise in stroke medicine. Following an incident highlighted though clinical governance, we started a QIP to improve this communication. <h3>Methods</h3> Our QIP, based at a DGH HASU, used Model for Improvement methodology, completing 4 PDSA cycles between February 2022 and June 2023. We targeted inclusion of selected critical information on 80% of discharge summaries. Progress was measured via audit of discharge summaries. Change ideas implemented included an EPR template (Cerner Millenium), task automation, handover and educational interventions. <h3>Results</h3> Descriptive information concerning patients’ strokes was adequately communicated, improving post intervention (75% to 85% of discharge summaries). Initially, secondary prevention information was included sporadically (39%). By cycle 4, this improved to 74% (p&lt;0.005), approaching 90% when the template was used. <h3>Conclusion</h3> While narrowly missing our target, our QIP demonstrated large improvements in the completeness of communication with GPs and patients. This improvement was primarily delivered through improved utilisation of often neglected aspects of EPR functionality. This makes our results widely applicable to stroke units seeking to improve this critical step in the patient journey.