Informing improved handover of care through discharge summaries from hospital to care home: a mixed methods evaluation using a health literacy approach

Background Medical discharge summaries (MDS) are a vital document, transferring information from the hospital to care teams in residential care homes on discharge. They support safe, patient-centred care communicating information about the patient's admission and post-discharge care including medications. However, MDS are not fulfilling their role, they are often aimed at other medical staff such as GPs, and so are poorly suited to the needs of adult social care professionals (referred to as carers in this document) who are likely to have different expertise and lower health literacy. 'The discharge summary is not so clear… there is a lot of medical terminology… the responsibility is on you to call the hospital and clarify' - carer. Aim: To support improved care for residents discharged to care homes from hospital by optimising the content and format of MDS so they are accessible to carers without a medical or nursing background. WP1: Investigating levels of health literacy and numeracy (HLN) of carers 1A: A systematic review of studies comparing the HLN of carers and nurses. 1B: A national online cross-sectional survey of carers working in residential care to measure their health literacy, health numeracy and ehealth literacy using a suite of validated measures. WP2: A mixed methods study to explore the purpose, form, content and style of MDS 2A: MDS from three trusts will be analysed looking at how easy they are to read and understand, and the mathematical proficiency and online skills needed to use them. The level of ability required will be compared to the skills level demonstrated in the survey in 1B. 2B: I will conduct 4 focus groups with the medical team and carers to explore their views on MDS and opportunities for improvement. I will also undertake a documentary analysis of key documents (e.g. medical school curriculums). WP3: Co-production of principles for writing MDS to meet the needs of care workers A range of experts and experts by experience including carers, residents/families, junior doctors and medical educators will be recruited to co-produce principles for writing MDS using a modified Delphi method. WP4: Testing the feasibility of generating lay summaries using natural language processing (NLP) algorithms In collaboration with machine learners at UCL, I will train an NLP algorithm, using the principles from WP3 and then test the AI models' ability to generate accessible lay summaries for carers from existing MDS. Patient and Public Involvement This project was co-produced with residents and carers and the methodology reviewed by the public considering its aims and how to improve the methodology to ensure it's accessible and inclusive for a range of participants. The study will be supported by a steering committee including carers, residents and their families. Impact The co-produced principles will support more effective communication through MDS, facilitating safe, effective and personalised care for residents on discharge to care homes. This will support reducing workloads for carers and reducing the likelihood of medical events and hospital readmissions through unclear care plans and so have costing saving benefits for the NHS.