General practice follow-up after hospital discharge in older adults: retrospective record analysis in UK primary care.

Abstract

Most hospital admissions are for older patients, who are more likely to be medically complex. Primary care risks after hospital discharge and readmission trajectories are relatively unexplored. To estimate the frequency and nature of errors and harms linked to discharge summary processing in general practice for patients aged ≥65 years; and to explore associations with readmission and healthcare utilisation, using a novel primary care data source. Retrospective cohort study using electronic health records (EHRs) from seven purposively sampled general practices in the West Midlands, UK. EHRs of patients aged ≥65 years discharged between October 2022 and October 2023 were reviewed. Outcomes included post-discharge healthcare utilisation and costs, frequency and type of discharge actions, error rates (failures to complete requested actions), harms (severity, attribution, and preventability), and 90-day readmissions. Multivariable logistic regression identified predictors of errors, harms, and readmission. Within the cohort of 263 discharged patients, 186 (70.7%) accessed post-discharge care; with 47 out of the 263 patients (17.5%; 95% confidence interval = 13.7 to 23.0) having related readmissions within 90 days. In total, 551 actions were requested in 160 discharge summaries. For those patients who required an action, 20.6% experienced error and 4.4% experienced harm. Most harms resulted in hospital readmission and three out of eight were preventable in primary care. Error and harm disproportionately affected patients who had dementia or a recorded carer. General practice should review their processes for responding to patient discharge information in order to improve patient safety post-discharge. Further research into tools to assist practices with transitions is warranted.