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

BACKGROUND: 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. AIM: 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. DESIGN AND SETTING: Retrospective cohort study using electronic health records (EHRs) from seven purposively sampled general practices in the West Midlands, UK. METHOD: 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. RESULTS: 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. CONCLUSION: 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.