FY1 · Clinical skills & reasoning

Discharge summaries and safe discharge

The document that carries your patient into primary care — and the checks that stop a discharge becoming a readmission.

Why this matters on day one

The discharge summary is often the only thing the GP ever sees about an admission. A vague one transfers risk out of the hospital without transferring the information, and medication changes made in hospital are a leading cause of post-discharge harm.

The sequence

1Diagnoses, not problems. A clear primary diagnosis and the secondary ones. "Chest pain" is a presentation; say what it turned out to be, or say explicitly that it remains undiagnosed and what was excluded.
2Medication changes, spelled out. For every change: what was started, stopped or altered, WHY, and for how long. Reconcile against the pre-admission list — an unexplained omission reads as an error and often gets reinstated by the GP.
3Outstanding results and actions. Name every pending result and say who is chasing it. Then state explicitly what you are asking the GP to do, and by when — "please recheck U&E in one week" rather than "GP to monitor".
4Follow-up and safety-netting. Clinic appointments arranged, investigations booked, and what the patient should do if things worsen — including specific symptoms and who to contact.
5Is discharge actually safe?. Observations stable, eating and drinking, pain controlled, mobility assessed, equipment and package of care in place, transport arranged, medications dispensed (including the time-critical ones), and the patient understands the plan. Involve therapy and social work early rather than on the morning of discharge.
6Give it to the patient too. A copy in plain language. Patients are the most reliable carrier of their own information between services.

What goes wrong

Medication changes with no reason recorded — the GP cannot safely continue or reverse them.
Pending results listed with no owner.
"GP to follow up" with no specifics.
Discharging before the package of care is confirmed, especially on a Friday.
Not sending the patient home with the time-critical drugs — Parkinson's medication, insulin, anticonvulsants.

Escalate when

A discharge you think is unsafe → say so, document it, and escalate. Pressure on beds is not a clinical justification.
A patient who lacks capacity and has no safe discharge destination → social work, safeguarding and senior involvement.
A patient with capacity discharging themselves against advice → document the discussion, the risks explained, and give the summary and safety-netting anyway.

NICE NG27 — transition between hospital and community · PRSB discharge summary standard · RCP records standards