Are general practitioners satisfied
with electronic discharge summaries?
Melanie Alderton and Joanne Callen
discharge summary which is mailed to the patients’ nominated GP. Eighty-five GPs were surveyed
satisfied with all eight documentation data elements. Some GPs indicated that they would prefer to
Computerised Patient Records; General Practice; Patient Discharge; Electronic Mail; Computerised Medical
The discharge summary document is an essential
vehicle for communication between general
practitioners (GPs) and hospitals as it provides
clinical and administrative information necessary
for continuity of care (Bolton et al. 1998; Bolton
2001; Wilson et al. 2001). Traditionally, discharge
summaries were completed manually by the
clinician responsible for the care of the patient
whilst in hospital and mailed to the GP upon
or soon after discharge. Discharge summaries
record information regarding the patient’s course
in hospital including significant test findings,
procedures performed, the patient’s response to
treatment and condition on discharge, including
medications and follow-up care (Abdelhak et al.
2001; Huffman 1991).
Studies have shown that two key issues for GPs
in relation to discharge summaries relate to the
quality of information in the discharge summary
and timeliness of receipt (Bolton et al. 1998;
Castelden et al. 1992). The items of information
to be included in the discharge summary which
GPs have identified as being of greatest impor-
treatment whilst in hospital
a list of diagnoses
management and outcomes
dates of admission and discharge (Castelden et
Interestingly, as early as the 1990s Castelden
and colleagues (1992) also found that most
GPs surveyed indicated that they would prefer
a computer generated discharge summary to a
A recent study on GPs’ attitudes regarding the
value of discharge summaries and the timeliness
of receipt found that 67% of GPs reported that
the discharge summary was either useful or very
useful; however, timeliness of receipt was still
an issue, with less than half receiving discharge
summaries within two weeks of the patient’s
discharge date (Middleton et al. 2004). Other
studies have shown similar results in relation to
timeliness of receipt (Schabetsberger et al. 2005;
Wilson et al. 2001). One study showed that in
2001 communication between hospitals and GPs
was at an unacceptably low level, with only 27%
of GPs ever receiving a discharge summary, two
thirds of whom reporting that they received it in a
timely manner (Wilson et al. 2001).
Information technology could facilitate
the discharge summary process as well as
the seamless sharing of information between
hospitals and primary care providers (Mann
2005). The patient’s electronic discharge
summary could be part of the clinical informa-
tion system which draws information from other
systems and is sent electronically to the patients’
local medical officer. Electronic preparation
and transfer of discharge summaries has been
suggested as one way of solving timeliness of
receipt (Wilson et al. 2001) and improving the
quality of information in the discharge summary
(Pagliari, Gilmour & Sullivan 2004).
The National E-Health Transition Authority
(NEHTA), which was established in 2005 as a
collaborative enterprise between the Australian
national and state/territory governments, is
developing standards for the secure exchange of
clinical information (National E-Health Transition
Authority n.d.). Hospital discharge summaries
and referrals will in future use standardised
data formats and terminologies. In July 2001
NSW Health released a document titled “Shared
responsibility for patient care between hospitals
and the community – an effective discharge
policy” (NSW Health 2001). The policy empha-
sises the importance of continuity of care and
communication on discharge between patients’
carers, service providers and GPs. It reports that
a major contributing factor to adverse events was
poor communication between acute and primary
care health professionals. The discharge summary
is the key communication between the GP and
the hospital and an electronic discharge summary
could facilitate this communication and hence
needs to be studied in depth.
The electronic discharge summary was intro-
duced in the study hospital in October 2004.
Although the summaries are produced electroni-
cally, they are manually transferred to GPs; the
electronic discharge summary is printed and then
mailed to the GP . The current study sought to
evaluate the electronic production and manual
transfer of the discharge summary in terms of GPs
satisfaction with the quality of information and
timeliness of receipt.
Design, study site and population
The study utilised a survey design and was
conducted in a Sydney metropolitan, 75-bed
public hospital which provides general medicine,
geriatric and rehabilitation services to the local
and wider community. The population consisted
of all GPs of patients who were discharged from
the hospital for a seven week period between
July and August 2005. The total number of GPs
satisfying the criteria for the audit period was
eighty-nine; however four had invalid phone or
fax numbers and these were not verified (n=85).
Surveys were sent to the 85 GPs of patients who
were discharged from the hospital for the period
of interest, whose length of stay was greater than
two days and who had an electronic discharge
summary completed and available for printing
from the clinical information system. Patients
who had died whilst an inpatient or who had
no GP listed were excluded. After one week the
non-respondent GPs were followed up with a
phone call. This procedure was repeated for
the following six weeks. In the first week the
surveys were mailed to the GPs whilst in subse-
quent weeks they were faxed to facilitate prompt
delivery. GPs were not sent more than one survey,
even if they had multiple patients discharged
within that period.
GP satisfaction survey and analysis of results
The GP satisfaction survey was based on previous
surveys (Middleton et al. 2004; Schabetsberger et
al. 2005; Wilson et al. 2001) and modified to suit
the study site. An area of particular interest to the
study hospital was the adequacy of information
contained in the electronic discharge summary
if the patient had been transferred from another
hospital without a completed discharge summary.
A question to capture that information was
added to the survey. The survey consisted of six
questions. The question asking GPs to rate their
satisfaction with the quality of information in
the electronic discharge summary included eight
data elements: amount of information; accuracy
of information; summary of progress; treatment;
follow-up and ongoing management; results;
medication, and layout of the discharge summary.
One free text question asked for suggestions for
improvement. The data were entered into the
Statistical Package for Social Sciences (SPSS)
version 11.0 (Coakes & Stead 2003) and analysed
using descriptive statistics.
Discharge summary production at the study site
The electronic discharge summary can be
commenced early in a patients’ admission and
is accessed by the treating doctor with a secure
login via a computer terminal through the
hospital clinical information system. Some data
elements such as patient demographics and name
and contact details of the patients’ general prac-
titioner are sourced from the existing patient
administration system and automatically populate
the document. Pathology and diagnostic results
can be also pulled across from the clinical hospital
information system. Discharge information is
entered via free text in the relevant sections.
Extra information can be added or modified prior
to completing and signing off the document. At
the time of this study, the discharge medications
were handwritten onto a pharmacy script, and
then transcribed again into the medication field
on the electronic discharge summary. It should
also be noted that while the generation of the
discharge summary is electronic, the means of
communication from the hospital to the general
practitioner is still manual with the electronic
summary either, posted, faxed, or sent with the
patient. It is not emailed.
Profile of the study population
A total of 85 surveys were either mailed or
faxed to GPs. The number of completed surveys
returned was 54, giving a response rate of 64%.
Overall satisfaction and timeliness of receipt
The majority of GPs surveyed agreed (93%) that
the electronic discharge summary was an overall
improvement on the manual discharge summary
Table ?: Number of GPs who agreed that the
electronic discharge summary was an improvement
on the manual discharge summary
When asked if they had received a discharge
summary for their recently discharged patients,
the responses indicated that the majority (83%)
of GPs had, and it had been received within two
weeks of the date of discharge (Table 2).
Table ?: Receipt and timeliness of receipt of the electronic discharge summary
? YeS? no?n/a
– Did you receive an electronic discharge summary for your patient?
within 2 weeks of discharge? 45 83.3 2 3.7 7 2?13
Adequacy of information for patients who were
The study hospital frequently admits patients who
are transferring from a nearby large acute care
facility. If the patient was transferred from this
facility, respondents were asked:
a) Did they receive a discharge summary from the
b) If they did not – did the electronic discharge
summary from the study hospital adequately
cover their treatment at the previous hospital?
The total number of patients transferred was 42
out of 54 (78%). Two thirds of these patients’
GPs did not receive a discharge summary from
the transferring hospital (Table 3). However, if a
discharge summary from the transferring hospital
was not received, then in most cases (76%)
the GP responded that the electronic discharge
summary from the study hospital adequately
covered the patients’ prior treatment at the trans-
Satisfaction rating of the quality and quantity of
information in the electronic discharge summary
It can be seen that the majority of GPs were either
satisfied or very satisfied with the electronic
discharge summary in all eight of the documenta-
tion data elements (Table 4).
Free text feedback from the GP
The responses to the free text question, Do you
have any comments or suggestions regarding
the electronic discharge summary? are grouped
into positive feedback and suggestions for
improvement. Five respondents said they would
like more information regarding follow up
and recommendations for ongoing care; four
responded that they would like to receive the
electronic discharge summary electronically
(Table 5). Other suggestions by the GPs included:
would like a phone call on discharge;
explanation of medications;
too many blood results;
too long with poor layout
no discharge date
Table ?: Receipt of discharge summary from the transferring hospital, and adequacy of the electronic
discharge summary to cover previous treatment ?
Did you receive a D/S from transferring hospital?
adequately cover prior treatment?
25 76 8 24
Table 4: GPs satisfaction with the quality and quantity of documentation
in the electronic discharge summary
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Table ?: GPs free text comments on the electronic
More information on follow-up/recommendations –?
– management plan, more detail
Too long, layout poor, hard to find the information*
Happy – sped up the management of patient
GP satisfaction with electronic discharge
Results from our study showed that GPs were
satisfied with electronic discharge summaries in
terms of timeliness of receipt and quality of infor-
mation. The literature reviewed identified three
items that were most important to GPs in relation
to discharge summaries:
treatment provided in hospital
instructions for follow-up
timeliness of receipt (Bolton 1998; Castelden
et al. 1992; Middleton et al. 2004; Wilson et
Our study showed that although three quarters of
GPs reported they were ‘satisfied/very satisfied’
with the two data elements, intervention/
treatment and follow-up/ongoing management,
there were a number who responded that they
were ‘neutral’ or ‘unsatisfied/very unsatisfied’.
These key documentation data elements require
further follow-up studies to ascertain reasons for
dissatisfaction by the GPs.
Literature on the timeliness of receipt of
the discharge summary shows this area is still
a cause for concern for local medical officers
(Middleton et al. 2004; Wilson et al. 2001). Our
study showed, however, that the majority of GPs
received the electronic discharge summary in a
timely manner, indicating that the study hospital
has a reasonably effective method of completion
and distribution of discharge summaries to the GP .
An indicator of successful implementation
of an information system is user satisfaction
(Westbrook & Gosling 2002). Our study showed
high levels of GP satisfaction with almost all
GPs surveyed reporting they were satisfied with
the electronic discharge and preferred it over
the manual discharge summary. Other literature
also reports that GPs prefer computer generated
discharge summaries over manual discharge
summaries (Castelden et al. 1992; Middleton et
The GP survey covered most discharges for
seven weeks and had a response rate of 64%. It is
therefore reasonable to conclude these results are
generalisable to other hospitals of a similar type
who use the same format of discharge summaries
as the ones used at the study hospital. As the
study hospital printed the electronic discharge
summary and mailed it to the GP the issue of
email transmission of the summary could not be
examined; suffice to say it would be desirable if
appropriate privacy and security mechanisms are
There are two limitations to this study which
should be taken into account when reviewing
the results. First, the study hospital has a regular
turnover of interns, residents and registrars, and
therefore the results reflect the quality of the
discharge summaries completed by the doctors
who were practicing at the hospital at the time
of the study. The second limitation rests with the
variation in comprehensiveness of the informa-
tion that the doctors document in the discharge
summary. This was not accounted for in the
A key recommendation from the study was
that education be provided to doctors, espe-
cially junior doctors, regarding the importance
of documenting clear instructions for the GP , in
order to assist with the ongoing management of
the patient following discharge from hospital.
In particular, attention should be paid to follow-
up instructions and the summary of a patients’
treatment in hospital. It is also recommended
that the date of discharge should automatically
populate the electronic discharge summary. Docu-
mentation of drug allergies and medication errors
should be further investigated.
The quality of information in the electronic
health record (EHR) is only as good as the quality
of all the individual components that feed into it.
As the discharge summary is one of the founda-
tion building blocks for the EHR, it is essential
that monitoring of quality and accuracy of
discharge summary information takes place on a
regular basis. This is particularly the case when
there is implementation of any new system or
updating of an existing system. Electronic transfer
of information to GPs as opposed to faxing or
mailing should also be explored.
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Melanie Alderton BAppSc (Hons.)
Health Information Manager
29 Booth Street
Balmain NSW 2041
Phone: +61 2 93952145
Fax: +61 2 93952148
Joanne L Callen BA, DipEd, MPH (Research), PhD
Faculty of Health Sciences
The University of Sydney
PO Box 170
Lidcombe NSW 1825
Phone +61 2 93519494
Fax: +61 2 93519672