Junior doctors' perspectives on the hospital discharge process: A qualitative study exploring preparation of discharge summaries and medication reconciliation.

Abstract

Background: Hospital discharge is a vulnerable point in a patient's journey where increased medication-related errors occur. Despite the importance of discharge summaries as a communication tool at the hospital-community healthcare interface, many factors impede doctors' ability to prepare accurate and timely discharge summaries and medication lists. Objective: To explore junior doctors' perceptions of the hospital discharge process. Method: Semi-structured interviews were conducted with purposively selected junior doctors (interns, residents and registrars) from a metropolitan health service between November and December 2022. The interview tool contained prompts to explore opinions and experiences relating to the discharge processes, specifically discharge summaries, medication reconciliation and collaboration between healthcare professionals. Interview transcriptions were thematically analysed. Results: Twenty junior doctors were interviewed. Five interconnected themes emerged: (1) workload and time restraints, (2) perceptions of medication reconciliation, (3) collaboration with pharmacists, (4) communication between healthcare professionals and (5) impact of organisational factors. Significant barriers to preparing discharge summaries included time pressures and high patient turnover. Factors aiding doctors included direct involvement in the patient's care, designated time to complete discharge summaries, well-documented in-patient progress notes and availability of comprehensive admission medication information recorded by pharmacists. Conclusion: Junior doctors face significant challenges during the hospital discharge process. Under heavy workloads and high patient turnover, continuity of care can be compromised as direct patient care tasks take priority over preparing discharge summaries. Implications for health information management practice: The findings underscore the need for enhanced medicines education and support for junior doctors, alongside improved integration of pharmacist expertise, to facilitate clear, accurate and timely discharge documentation.