An ethnography of General Practice inpatient discharge summary management for older patients.

Background: Post-inpatient discharge is a risky time for older patients, especially those with polypharmacy and multi-morbidity. General practice care at this time, including the processes for managing hospital discharge summaries, lacks standardisation and is of variable quality. Understanding these processes will support the design of interventions and guidance to improve general practice management of the post-discharge period.

Aim: Understand and visualise how ongoing care for older people after discharge from hospital is organised in general practice, including the processes for managing discharge summaries.

Design and setting: 10 practices in the West Midlands, England took part in a rapid ethnography in which we mapped their systems of post-discharge care.

Method: Data sources included: informal conversations with staff, practice policies and direct observations of discharge summary handling. Fieldnotes and quotes were subject to an interpretivist framework analysis. A systems modelling technique (FRAM) was used to present visual representations of the professional roles working in these complex systems.

Results: Three basic typographies of system emerged based on professional roles: GP led, Pharmacist led and Administrative led. We report on three themes which weave around the FRAM process maps: comfort with demands of administrative role; general practice team dynamics; and interaction with patients.

Conclusion: General practice systems for inpatient discharge summary processing are complex and varied. New roles in general practices are being used extensively, often requiring significant input in supervision by GPs. Our findings highlight safety features of different systems and should help practices understand the advantages/limitations of models they work within.