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SIGN 128 The SIGN discharge document

June 2012

Improvement

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This document is produced from elemental chlorine-free material and is sourced from sustainable forests.

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Scttish Intercllegiate Gidelines Netwrk

The SIGN discharge dcent

Jne 2012

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The SIGN discharge dcument

Scttish Intercllegiate Gidelines Netwrk

Ellitt Hse, 8 -10 Hillside Crescent

Edinbrgh EH7 5EA

www.sign.ac.k

First published June 2012

ISBN 978 1 905813 89 6

Citatin text

Scttish Intercllegiate Guidelines Netwrk (SIGN).

The SIGN discharge dcument. Edinburgh: SIGN; 2012.

(SIGN publicatin n. 128). [June 2012].

Aailable rm URL: http://www.sign.ac.uk

SIGN cnsents t the phtcpying this guideline r the purpse

implementatin in NHSSctland.

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Cntents

1 Intrdctin ............................................................................................................................................................1

1.1 The need r a SIGN discharge dcument ...........................................................................................................................1

1.2 Remit the SIGN discharge dcument ...............................................................................................................................1

2 The discharge dcent ......................................................................................................................................3

2.1 The cntent the discharge dcument .............................................................................................................................3

2.2 Use the discharge dcument ..............................................................................................................................................3

3 The SIGN discharge dcent teplate ...........................................................................................................5

4 Ipleenting the SIGN discharge dcent ..................................................................................................10

4.1 Intrductin....................................................................................................................................................................................10

4.2 Implementatin strategy ...........................................................................................................................................................10

5 Deelpent the SIGN discharge dcent ...............................................................................................11

5.1 Intrductin....................................................................................................................................................................................11

5.2 The SIGN discharge dcument deelpment grup.......................................................................................................11

5.3 Cnsultatin and peer reiew ..................................................................................................................................................12

Abbreiatins ..........................................................................................................................................................15

Reerences................................................................................................................................................................16

Cntents

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The SIGN discharge dcumentThe SIGN discharge dcument

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1 Intrdctin

1.1 THE NEED oR A SIGN DISCHARGE DoCumENT

The preparatin and sharing accurate and timely recrds care and treatment are central aspects gd

clinical practice and the principles gd medical practice set ut by the General Medical Cuncil (GMC)1

will therere apply in the prisin discharge dcuments.

Patients wh are discharged rm hspital will be discharged back int the care the general practitiner

(GP) with whm they are registered. Essential inrmatin abut the patients stay in hspital that allws the

GP t cntinue the patients care and management llwing their discharge rm hspital is sent by the

hspital t the patients GP in the rm a Discharge Dcument (DD). There are currently tw rms DD

in use: the Immediate Discharge Dcument (IDD), which shuld be sent t the GP n the day discharge,

and a discharge summary r letter, which cntains mre detailed inrmatin abut the patients stay in

hspital and is sent ut, ideally, within a week the patients discharge date. The cntent, structure and

prductin (particularly the timeliness) discharge dcuments hae lng been a cause r cncern and inrder t try t address these issues, a minimum dataset r the IDD was published by SIGN in 1996 (SIGN 5)2

and reised and updated by SIGN in 2003 (SIGN 65).3

Impring the quality and timeliness discharge dcuments may lead t imprements in patient saety

by impring the prcess transitin rm hspital t GP care.

1.1.1 THE NEED FoR AN UPDATE

This SIGN DD replaces SIGN 65 and relects a number deelpments including adances that hae been

made with regard t the prductin, use and transmissin electrnic dcuments within NHSSctland,

changes in terminlgy, and the imprtance medicines recnciliatin. SIGN 5 and SIGN 65 relected the

act that many discharge dcuments were still prduced and/r printed n paper and transmitted by pst,

hand r ax. This update relects the act that the prductin and cmmunicatin dcuments by electrnic

means within bth primary and secndary care is becming mre cmmn.

Despite these deelpments, the essential cmpnents a DD remain largely unchanged with the cntent,

quality and accuracy the inrmatin cntained in the DD and timely transmissin t the GP being the

key aspects.

1.2 REmIT o THE SIGN DISCHARGE DoCumENT

1.2.1 ovERALL oBJECTIvES

The aim this dcument is t present a template r a single discharge dcument that can be used as bth

the IDD (in its cre rmat) r eery patient n the day discharge, and as the inal discharge summary/

letter (in its extended rmat) r mre cmplex cases.

The SIGN DD is designed r patients wh are discharged rm hspital llwing an inpatient stay, ie, a

stay in hspital ne night r mre. It culd als, hweer, rm the basis a DD r patients receiing

treatment n a daycase basis.

The SIGN IDD is nt designed t cer discharges rm psychiatric care because the special inrmatin

needs relating t this grup patients, but it culd rm the basis a DD tailred t the needs this grup.

The SIGN DD is eectiely a minimum dataset. As such the template shuld nt limit the inrmatin prided

and, where necessary, additinal inrmatin relating t, r example, anticipatry care planning, shuld be

prided either in the DD r separately, as apprpriate.

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Intrductin

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1.2.2 TARGET USERS oF THE SIGN DICHARGE DoCUMENT

The SIGN DD is releance t all hspital medical and nursing sta, allied health pressinals, general

practitiners, cmmunity nurses, pharmacists, and uthurs serices.

The SIGN DD is nt intended t be the sle r main surce inrmatin r patients, their carers r relaties,

althugh mst will receie a cpy at the time discharge rm hspital.

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2 The discharge dcent

2.1 THE CoNTENT o THE DISCHARGE DoCumENT

SIGN 5 argued the imprtance a minimum dataset as a basis r electrnic data transer and speciied such

a dataset; SIGN 652 reined the riginal dataset t encurage imprements in the standard discharge

dcuments in this critical area practice. It was recgnised in SIGN 65 that a minimum dataset shuld be

eidence based and include all thse items seen as essential.3

The SIGN DD is based n a reiew SIGN 65 by a multidisciplinary grup (see section 5.2) using an amended

ersin the SIGN guideline deelpment prcess (see sections 5.1 and 5.3). The cntent, althugh similar

t SIGN 65, has been reised and updated; sme existing items hae been deleted r changed, new items

hae been added and the guidance ntes hae been reiewed and extended.

2.2 uSE o THE DISCHARGE DoCumENT

The SIGN DD is a single discharge dcument template, with cre and extended rmats, r use within

NHSSctland.

The cre discharge dcent (CDD), which replaces the IDD, must be prduced r all patients n the day

discharge. In cases where the patients stay in hspital is brie and uncmplicated and where there are n

utstanding test results r inestigatins, the CDD will be the sle discharge dcument.

Fr mre cmplex cases where mre detailed inrmatin abut the hspital stay r llwup arrangements

is required, r where the results tests and inestigatins are awaited, an extended discharge dcent

(EDD) will als hae t be cmpleted. In cases where an EDD is required, the CDD, which will be retained n the

hspital inrmatin system, can be extended and augmented by the additin mre detailed inrmatin

in speciied ields t prduce the EDD. When an EDD is prduced it is imprtant, r audit purpses, that the

CDD is retained n the system unchanged.

The EDD shuld be sent ut within seen days the date discharge t ensure that the GP has all the

inrmatin required r the nging care and management the patient. In cases where imprtant

inrmatin, such as test results, is nt aailable within seen days, dispatch the EDD can be delayed until

the inrmatin is aailable but this delay shuld nt exceed 14 days.

All releant members the multidisciplinary hspital team shuld be inled in the prductin the

CDD and the EDD. The acility t autmatically transer inrmatin rm nursing, pharmacy, physitherapy,

ccupatinal therapy and ther releant recrds wuld greatly acilitate this prcess.

2.2.1 CoDING oF DIAGNoSES, oPERATIoNS AND PRoCEDURES

Accurate reprting all diagnses, peratins and prcedures releant t a patients admissin is an essential

part bth the CDD and the EDD. This inrmatin is central t the uture care and management the

patient and essential r accurate cding and recrd keeping within hspital and general practice recrds

systems. Clear textual descriptins these items must therere be gien.

In additin t textual descriptins, bth the CDD and the EDD ask r standard cdes t be prided r

these items where pssible. Hweer, there is currently n natinal deinitin standard cdes acrss

NHSSctland with hspitals tending t use the Internatinal Statistical Classiicatin Diseases and Health

related Prblems, tenth reisin (ICD10) and the oice Ppulatin Censuses and Sureys Classiicatin

Surgical operatins, urth reisin (oPCS4) and general practices tending t use Read cdes. Althugh the

adptin a single cding system (eg the Systemised Nmenclature Medicine Clinical Terms (SNoMED

CT) acrss NHSSctland wuld greatly acilitate the transer inrmatin between, r example, hspitalsand general practices, until such a system is agreed the deinitin what cnstitutes a standard cde will

be a matter r lcal agreement. The extent t which standard cdes are included in the CDD and EDD will

als depend n lcal systems and prcesses.

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2.2.2 MEDICINES RECoNCILIATIoN AT DISCHARGE

The accurate recrding medicines is an essential cmpnent the CDD and EDD as it has a direct impact

n patient care and management and is an imprtant actr in impring patient saety. In the cntext

bth the CDD and EDD, medicines recnciliatin cmprises the accurate recrding and cmparisn all

medicines a patient was taking n admissin t hspital with thse they are taking at the time dischargerm hspital, dcumenting all changes that hae taken place. Changes can include the prescriptin

new medicines, changes t existing medicines (such as changes t dse r requency) and the stpping

medicines that the patient was taking at the time admissin t hspital.

T relect the imprtance including accurate inrmatin n all new, cntinuing and stpped medicines,

the SIGN DD nw includes separate and extended sectins r recrding this inrmatin alng with mre

detailed guidance ntes r cmpletin.

Sharing the discharge dcument with the patients cmmunity pharmacist is cnsidered t be an imprtant

step in impring medicines recnciliatin at discharge and enhancing patient saety relating t medicines.

The decisin t share the DD with the cmmunity pharmacy must, hweer, be made in accrdance with

lcal prtcls.

2.2.3 CoNSULTANT SIGN-oFF

In cases where the CDD is the sle discharge dcument it must be signed by the cnsultant r senir

dctr wh is respnsible r crdinating the care the patient at the time discharge. I cnsultant r

senir dctr sign is nt pssible at the time discharge, an unsigned cpy the CDD shuld be sent

n the day discharge llwed by a signed cpy within seen days discharge.

In cases where the CDD is t be llwed by an EDD, the CDD des nt hae t be signed by the cnsultant

r senir dctr crdinating the care the patient, althugh it is gd practice t d s wheneer pssible.

The EDD must always be signed by the cnsultant r senir dctr respnsible r crdinating the care

the patient at the time discharge.

The deinitin senir dctr will be a matter r lcal agreement.

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3 The SIGN discharge dcent teplate

Ite ields Ntes

Items shwn in bld are essential

r the cre and extended

discharge dcument.

Items nt in bld are desirable r

the extendeddischarge dcument.

The core discharge dcument (CDD) cmprises all the

items shwn in bld and must be cmpleted r all

patients at the tie discharge. Fr uncmplicated

cases, this will rm the sle discharge dcument.

The extendeddischarge dcument (EDD) cmprises all

the items shwn in bld plus all the items nt in bld and

shuld be cmpleted r mre cmplex cases.

1 Hspital Nae This will be autmatically ppulated rm the hspitals

patient administratin system (PAS).

2

Patient ID CHI nber title

renae* alternatie rename srnae* address* pstcde* date birth*

This item will be autmatically ppulated rm the PAS.

CHI the Cmmunity Health Index number.

* These elds will be ppulated autmatically when the CHI

number is entered.

Alternatie rename the name by which the patient is

usually knwn (i diferent rm rename).

3 GP ID y renae

y srnae

y GP practice (cde)

y address

y pstcde

y ther GP name

These elds will be autmatically ppulated when the CHI

number is entered.

other GP name the GP respnsible r the patients

admissin, i diferent rm abe.

4 Cnsltant ID y renae

y srnae

y specialty

y cntact details

The cnsultant respnsible r the patient at the time

discharge.

Cntact details must be gien. This can be, r example,

telephne number, bleep number r email address, as

agreed lcally.

5 Ward/

Departent

Text The number/name the ward r department issuing the

discharge dcument.

6 Cntact Telephne nber This is the cntact telephne number r the ward r

department respnsible r the discharge.

7 Date

adissin

Date This is the date admissin t the hspital identied in

item 1.

8a Date

discharge

Date I the patient was discharged alie, recrd the date

discharge rm the hspital identied in item 1.

I item 8a is cmpleted, 8b must be blank.

8b Date death Date I the patient died during admissin t the hspital

identied in item 1, recrd the date death.

I item 8b is cmpleted, item 8a must be blank.

9 Priary

discharge

diagnsis

y priary diagnsis (text)

y cnred/prisinal

y cde

Recrd the primary discharge diagnsis releant t this

admissin. This is the main reasn why the patient was

admitted t hspital n this ccasin.

y Aid acrnyms, eg, STEMI, and abbreiatins, asthese may nt be understd by the recipients,

including patients.

y State whether the diagnsis is cnrmed r

prisinal.

y Pride standard cde(s) wheneer pssible.

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Item Fields Notes

10 Secndary

discharge

diagnsis/es

y secndary diagnsis/es

y cnred r prisinal

y cde(s)

Recrd any secndary diagnsis/es releant t this

admissin. Include any releant cmrbidities that

culd hae cntributed t r be afected by the primary

diagnsis (eg, hypertensin in a patient admitted rstrke).

y Aid acrnyms, eg, PvD, and abbreiatins, as these

may nt be understd by the recipients, including

patients.

y State whether each diagnsis is cnrmed r

prisinal.

y Pride standard cde(s) whereer pssible.

11 Presenting

cplaint

Text descriptin This is the reasn why the patient was admitted t hspital,

eg, breathlessness, chest pain, cllapse.

12 mde

adissin

Electie/eergency/transer This will be autmatically ppulated rm the PAS.

13 Srce

reerral

GP/sel-reerral/ablance

serice/t--hrs serice/ther

hspital/NHS24/ther (please

speciy)

This describes wh made the decisin t reer the patient

t (this) hspital.

14 Signicant

peratins/

prcedres

y text descriptin

y dates peratins/

prcedures

y cde(s)

All signicant peratins and/r prcedures (eg,

chemtherapy) shuld be described.

y Aid acrnyms, eg, CABG, and abbreiatins, as

these may nt be understd by the recipients,

including patients.

y Gie dates peratins/prcedures were undertaken i

releant r llwn care.

y Pride standard cde(s) whereer pssible.

15 Clinical prgress y text descriptin

y inestigatins

y cplicatins

y cde(s)

y ther releant inrmatin

Pride a descriptin what happened t the patient

during this admissin including, as a minimum:

y releant inestigatins perrmed

y a descriptin any cmplicatins (medical and/

r surgical) experienced by the patient. I nne, this

must be stated, eg, uncmplicated appendicectmy

and recery

y aderse reactins t medicines (i nt cered under

item 19) r treatments.

Standard cdes shuld be prided whereer pssible.

Fr extended discharge dcuments, recrd any ther

inrmatin that is releant t the admissin and which willassist llwn care.

16 Reslts awaited Y/N

I Yes speciy (text)

Speciy the type results that are awaited, eg, pathlgy,

inestigatins, imaging, and indicatins r tests/

inestigatins/imaging.

17 Inestigatins

pending

Y/N

I Yes speciy (text)

Describe all inestigatins that are pending at the time

discharge.

18 Allergies Y/N/undeterined

I Yes speciy (text)

Describe all knwn allergies and the rm they take. Fr

example:

Allergy penicillin; reactin rash.

Allergy peanuts; reactin anaphylaxis.

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Item Fields Notes

19 Stpped

edicines n

discharge

y nae edicine (generic

where pssible)

y rlatin

y strength preparatiny crrent dse

y rte adinistratin

y reqency

y reasn r stpping (text)

Recrd all medicines that the patient was taking at the time

admissin but was nt taking at the time discharge.

Describe the reasn why each medicine listed here wasstpped. This shuld include inrmatin n aderse

reactins.

In cases where the rmulatin, strength, dse, rute

administratin r requency a medicine has changed

between admissin and discharge, the medicine shuld be

recrded under item 19 and the new prescriptin recrded

under item 20.

20 New edicines

n discharge


where pssible)

y rlatin

y strength preparatin

y crrent dsey rte adinistratin

y reqency

y dratin treatent (stp

date r cntine)

y nber days spply

y aids t cpliance (text)

y reasn r change t

adissin edicines

y indicatins r new medicines

Recrd new medicines prescribed during this hspital stay

that are still being taken at the tie discharge. D

nt include medicines that were nly taken (ie, that were

started and stpped) during the patients stay in hspital.

A new medicine is dened as:

y any medicine that the patient was nt taking at the

time admissin

y any medicine that the patient was taking at the time

admissin but r which the rmulatin, strength,

dse, requency, r rute administratin has been

changed. In such cases a matched recrd must appear

under item 19.

Duratin treatment:

y recrd the stp date r all medicines prescribed r a

shrt term r dened curse treatment

y

recrd cntinue i the patient is t cntinue taking themedicine ater discharge and n specic stp date has

been agreed.

Number days supply recrd the number days supply

each medicine that was gien t the patient, carer r

relatie at the time discharge. I nne, recrd nne.

Aids t cmpliance pride a descriptin any aids t

cmpliance (eg, easypen cntainers, medicatin charts,

cmpliance deices, medicatin management serice ia

carer) that hae been prided t r are being used by the

patient t aid the taking medicines. I there are nne,

state nne.

Reasn r change t admissin medicatin i changes

hae been made t the rmulatin, strength, dse,

requency r rute administratin medicines that the

patient was taking at the time admissin, recrd the

reasns why these changes were made.

Indicatins r new medicines r medicines that are new,

ie, that were nt being taken by the patient at the time

admissin, describe what the new medicine has been

prescribed r as this may nt be clear t the GP r patient

rm the name the medicine alne.

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Item Fields Notes

21 Cntining

edicines n

discharge


where pssible)

y rlatin

y strength preparatiny crrent dse

y rte adinistratin

y reqency

y dratin treatent (stp

date r nging)

y nber days spply

y aids t cpliance (text)

Recrd all medicines where the admissin and discharge

prescriptin details are the same.

I any aspect the prescriptin has changed, themedicine must be recrded in item 19 and then the new

prescriptin recrded in item 20. This includes changes t

thermulatin, strength, dse, rute administratin r

requency.

Duratin treatment:

y recrd the stp date r all medicines prescribed r a

shrt term r dened curse treatment

y recrd cntinue i the patient is t cntinue taking the

medicine ater discharge and n specic stp date has

been agreed.

Number days supply recrd the number days supply each medicine that was gien t the patient, carer r

relatie at the time discharge. I nne, recrd nne.

Aids t cmpliance pride a descriptin any aids t

cmpliance (eg, easypen cntainers, medicatin charts,

cmpliance deices, medicatin management serice ia

carer) that hae been prided t r are being used by the

patient t aid the taking medicines. I there are nne,

state nne.

22 llw p

arrangeents

y Y/N

y I Yes, speciy (text)

y Text descriptin

Speciy the type llw up that is required, stating when

and by whm. Gie dates i knwn. Include, r example:

y early reiew by GP

y

hspital reiew (state by whm, eg, rheumatlgy)y scial wrk

y nursing (state r what)

y allied health pressinal (speciy which and r what)

y luntary rganisatins (eg, Macmillan, British Heart

Fundatin, Parkinsns UK).

In cmplex cases, a text descriptin detailing the nature

the llwup arrangements shuld be prided alng with

details supprt already prided r arranged.

23 Cpy t

cnity

pharacy

Y/N

I Yes speciy (text)

Select Yes i a cpy the discharge dcument has been

sent t the cmmunity pharmacy and gie the name the

pharmacy.

24 Cpy t patient Y/N Select Yes i a cpy the discharge dcument has been

gien t the patient.

25 Cpy t carer/

relatie

Y/N

I Yes speciy (text)

Select Yes i a cpy the discharge dcument has been

gien t the patients carer r relatie and state carer/

relatie's relatinship t patient.

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Item Fields Notes

26 Extended

discharge

dcent t

llw

Y/N Select Yes i this dcument rms the cre discharge

dcument nly and an extended discharge dcument is

t llw. This will apply t mre cmplex cases where

all releant inrmatin was nt aailable at the time discharge.

Fr all ther cases, select N.

27 other

inratin

Text Recrd any ther inrmatin cnsidered imprtant and

releant t this patient that is nt captured elsewhere in

the DD. This might include, r example:

y inrmatin n medicines n admissin nt knwn r

incmplete prir t discharge

y inrmatin n anticipatry care planning

y inrmatin relating t the patients understanding

their cnditin

y details inrmatin that has been prided t the

patient and/r their carer r relatie

y inrmatin n the patients tness t wrk.

Additinal inrmatin relating specically t llwup

arrangements shuld appear in item 22.

28 Cnsltant

sign-f and

cent

y Y/N

y Cmment

The cnsultant respnsible r the patient at the time

discharge (as named in item 4) must check and sign f the

discharge dcument (see sectin 2.2.3).

Select yes i this is:

y the cre discharge dcument checked and signed by

the cnsultant n the day discharge

y a signed replacement r a preiusly unsigned cre

discharge dcument

y an extended discharge dcument.

Select n nly i this is an unsigned cre discharge

dcument. In all such cases either a signed cre discharge

dcument r an extended discharge dcument must

llw within seen days discharge.

29 Signatre and

nae and

psitin

y signatre

y legible text nae

y jb title

y cntact telephne nber

T be cmpleted by the respnsible persn at the time

discharge, eg, charge nurse, senir nurse r senir medical

staf. They are signing n behal the persn named in

item 4 wh is respnsible r the dcument.

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4 Ipleenting the SIGN discharge dcent

4.1 INTRoDuCTIoN

The SIGN DD prides a standard template r discharge dcuments acrss NHSSctland incrprating all

the key ields required in a CDD and an EDD alng with a descriptin hw the dierent items and ields

shuld be cmpleted. I used cnsistently acrss NHSSctland the template shuld lead t imprements in

the quality discharge dcuments by acilitating the inclusin all key items inrmatin. Imprements

in the quality and timeliness discharge dcuments, hweer, will be dependent upn the existence

lcal systems and prcesses r their prductin and transmissin and it is the respnsibility NHS bards

t ensure that these are in place.

It is recgnised that the deelpment and use systems r the capture, use and transmissin electrnic

inrmatin releant t the discharge dcument aries acrss Sctland, within NHS bards and between

hspitals and lcal GP practices, and r that reasn n speciic recmmendatins are made abut hw the

SIGN DD shuld be generated, updated and used.

The CDD and EDD relect the minimum inrmatin that shuld be captured r bth straightrward and mre

cmplex discharges. It can, curse, be augmented as required t relect lcal pririties and circumstances.

4.2 ImPLEmENTATIoN STRATEGY

1. SIGN will wrk with the eHealth lead at Healthcare Imprement Sctland, the eHealth leads in

NHSSctland and ther releant pressinals t supprt the implementatin the SIGN DD.

2. A crdinated apprach t implementatin will be taken in cnjunctin with ther releant initiaties

and grups within Healthcare Imprement Sctland including:

Natinal Clinical Data Adisry Grup

Scttish Patient Saety Prgramme in Primary Care.

3. An initial targeted distributin will be undertaken and the DD will be reely aailable t dwnlad rm

the SIGN website.

4. Awarenessraising actiities will be undertaken wheneer pssible, ia releant meetings, cnerences

and rganisatins, including, in the irst instance:

distributin cpies the DD at the NHSSctland eent in June 2012

inclusin a pster at the primary care satellite eent, held as part the NHSSctland eent.

5. Audit tls r healthcare pressinals in training and thers wrking in NHSSctland will be deelped

t supprt audit key aspects the DD such as:

cnsultant sign

prprtin CDDs sent ut n the day discharge and the prprtin EDDs sent ut within

seen days discharge

pharmacy audit medicatin errrs.

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5 Deelpent the SIGN discharge dcent

5.1 INTRoDuCTIoN

SIGN is a cllabratie netwrk clinicians, ther healthcare pressinals and patient rganisatins and

is part Healthcare Imprement Sctland. SIGN guidelines are deelped by multidisciplinary grups

practising clinicians using a standard methdlgy based n a systematic reiew the eidence. Further

details abut SIGN and the guideline deelpment methdlgy are cntained in SIGN 50: A Guideline

Deelpers Handbk, aailable at www.sign.ac.k.

The SIGN DD is nt a guideline as such but an update and replacement r the IDD that rmed sectin

3 SIGN 65. The usual prcess r guideline deelpment set ut in SIGN 50 des nt therere apply. In

particular, a systematic reiew the literature was nt undertaken because the cntent the discharge

dcument (in terms tpics cered) remains largely unchanged (see section 1.1.1) and the cus much

the recent literature is n the prcesses surrunding the prductin, use and transmissin discharge

dcuments and cnsideratin these is nt within the remit this dcument. In cmmn with the usualprcess r guideline deelpment, hweer, the reiew was cnducted by a multidisciplinary grup

cnened speciically r this purpse and a drat the DD was sent ut r expert peer reiew and made

publically aailable r cmment n the SIGN website prir t being inalised (see section 5.3).

5.2 THE SIGN DISCHARGE DoCumENT DEvELoPmENT GRouP

Dr Keith Brwn Chair, SIGN

(Chair)

Mrs Jackie Caldwell Information Consultant, Information Services Division, Edinbugh

Mrs Michele Caldwell Director of Pharmacy, NHS Ayrshire and Arran, Ayr

Ms Beatrice Cant Programme Manager, SIGN

Dr Allan Camern Consultant Physician, Glasgow Royal Infirmary

Mr Mike Chen Community Pharmacist, Meadowbank Health Centre, Polmont

Dr Lynne Gallway General Practitioner, Kelburn Surgery, Paisley

Dr Claire Grdn Consultant in Acute Medicine, Western General Hospital, Edinburgh

Dr Rachel Green GP Trainee, Edinburgh

Mr Peter Lamb Consultant Surgeon, Royal Infirmary of Edinburgh

Dr Jhn McKnight Consultant Physician, Western General Hospital, Edinburgh

Dr Libby Mrris General Practitioner, Hermitage Medical Practice, Edinburgh

Mr Richard Murray Clinical Standards Facilitator (Mental Health), Royal Edinburgh Hospital

Pressr Aziz Sheikh Professor of Primary Care Research and Development, University of

Edinburgh

Dr Gregr Smith Divisional Medical Director, NHS Lanarkshire, Bothwell

The membership the guideline deelpment grup was cnirmed llwing cnsultatin with the member

rganisatins SIGN. All members the guideline deelpment grup made declaratins interest and

urther details these are aailable n request rm the SIGN Executie.

Guideline deelpment expertise, supprt and acilitatin were prided by the SIGN Executie. All members

the SIGN Executie make yearly declaratins interest and urther details these are aailable n request.

Lisa Birch Distribution and Office Coordinator

Stuart Neille Publications Designer, SIGN Executive

Gaynr Rattray Senior Guideline Coordinator, SIGN Executive

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5.2.1 ACKNoWLEDGEMENTS

SIGN wuld like t acknwledge the guideline deelpment grup respnsible r the deelpment SIGN

65 The Immediate Discharge Dcument, n which this discharge dcument is based.

5.3 CoNSuLTATIoN AND PEER REvIEW

5.3.1 PUBLIC CoNSULTATIoN

The drat SIGN DD was aailable n the SIGN website r three weeks t allw all interested parties t cmment.

5.3.2 SPECIALIST REvIEW

This DD was als reiewed in drat rm by the llwing independent expert reerees, wh were asked t

cmment primarily n the cmprehensieness the dcument. The deelpment grup addresses eery

cmment made by an external reiewer, and must justiy any disagreement with the reiewers cmments.

All expert reerees made declaratins interest and urther details these are aailable n request rm

the SIGN Executie.SIGN is ery grateul t all these experts r their cntributin t the discharge dcument.

Miss Wendy Ackryd Lead Clinical Pharmacist, Mental Health, Dumfries and Galloway Royal

Infirmary

Mr Andrew de Beaux Consultant Surgeon, Edinburgh Royal Infirmary

Mrs Marg Biggs Lay representative, Falkirk

Ms Susan Bishp National Lead Primary Care, Community and Outpatients, Scottish

Government

Ms Kate Burtn Public Health Practitioner, NHS Lothian

Dr Patrick Cadigan Registrar, Royal College of Physicians, LondonPressr Jhn Cia Specialty Adviser for Medical Microbiology, Scottish Medical and

Scientific Advisory Committee and SGHSCD Specialty Adviser

Mr Graeme Cnn Specialty Adviser for Urology, Scottish Medical and Scientific Advisory

Committee and SGHSCD Specialty Adviser

Dr Wendy Craig Clinical Research Fellow and Specialist Registrar in General Surgery,

Aberdeen Royal Infirmary

Dr Patricia Dnald Specialty Adviser for General Practice, Scottish Medical and Scientific

Advisory Committee and SGHSCD Specialty Adviser

Dr Graham Ellis Clinical Manager, St Johns Hospital, Livingston

Mr Clin Fergussn Community Pharmacist, Colin Fergusson Pharmacy, GlasgowMs Jann Gardner Lead Pharmacist, Acute Services, Forth Valley Royal Hospital, Larbert

Mr Duglas Gentleman Specialty Adviser for Rehabilitation Medicine, Scottish Medical and


Ms Shelley Gray Director of Policy and Communications, Long Term Conditions Alliance

Scotland

Dr Anne Hendry National Clinical Lead for Quality, The Scottish Government

Dr Richard Herrit Consultant Immunologist, Aberdeen Royal Infirmary

Dr Liz Junr Consultant Clinical Oncologist, Edinburgh Cancer Centre, Western

General Hospital, Edinburgh

Dr Aileen Keel Deputy Chief Medical Officer, The Scottish Government

Dr Graham Kramer General Practitioner, Links Health Centre, Montrose

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Dr Diane Kelly National Lead for GP CPD, Assistant Director Collective Learning, NHS

Education for Scotland

Dr Jhn Paul Leach Specialty Adviser for Neurology, Scottish Medical and Scientific Advisory

Committee and SGHSCD Specialty Advisers

Dr Alastair Leckie Specialty Adviser for Occupational Health, Scottish Medical andScientific Advisory Committee and SGHSCD Specialty Adviser

Pressr Graham Leese Specialty Adviser for Diabetes/Endocrinology, Scottish Medical and


Dr Katherine Leightn Specialty Adviser for Child & Adolescent Psychiatry, Scottish Medical and


Dr Christpher Lush Specialty Adviser for Haematology, Scottish Medical and Scientific


Dr Carrie MacEwen Specialty Adviser for Opthalmology, Scottish Medical and Scientific


Mr Andy Malyn Specialty Adviser for Plastic Surgery, Scottish Medical and ScientificAdvisory Committee and SGHSCD Specialty Adviser

Dr Alisn McCallum Specialty Adviser for Public Health, Scottish Medical and Scientific


Dr Pauline McCnille Consultant Psychiatrist and Associate Director of Medical Education,

Royal Edinburgh Hospital

Ms Annamarie McGregr Professional Support Pharmacist, The Royal Pharmaceutical Society,

Scottish Office, Edinburgh

Dr Mira McGuigan Specialty Adviser for Homeopathy, Scottish Medical and Scientific


Dr R M Milne Chair, Scottish Clinical Information Management in Practice (SCIMP),Edinburgh

Dr Mini Mishra Senior Medical Officer, The Scottish Government

Dr Clie Prestn Specialty Adviser for Palliative Medicine, Scottish Medical and Scientific

Advisory Committee and SGHSCD Specialty Advisers

Pressr Bill Sctt Chief Pharmaceutical Officer, The Scottish Government

Mr Patrick Statham Consultant Neurosurgeon, Western General Hospital, Edinburgh

Pressr Alisn Strath Chair in Community Pharmacy Practice, Robert Gordon University,

Aberdeen

Dr Jeremy Thmas Specialty Adviser for Diabetes/Endocrinology, Scottish Medical and


Ms Catherine Tully Prescribing Support Pharmacist, East Renfrewhshire Community Health

and Care Parternship

Dr Stee Twaddle General Practitioner, Abronhill Medical Group, Cumbernauld

Dr Barry vallance Specialty Adviser for Cardiology, Scottish Medical and Scientific Advisory

Committee and SGHSCD Specialty Adviser

Mr Bruce Wilkie Principal Pharmacist, Service Development, Queen Margaret Hospital,

Dunfermline

Pressr Daid Wilsn Professor of Paediatric Gastroenterology and Nutrition, Child Life and

Health, University of Edinburgh

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5.3.3 SIGN EDIToRIAL GRoUP

As a inal quality cntrl check, the discharge dcument was reiewed by an editrial grup cmprising the

releant specialty representaties n SIGN Cuncil t ensure that the specialist reiewers cmments were

addressed adequately and that any risk bias in the deelpment prcess as a whle was minimised. The

editrial grup r this discharge dcument was as llws. All members the SIGN Editrial grup makeyearly declaratins interest and urther details these are aailable n request rm the SIGN Executie.

Dr Sara Twaddle Director, SIGN; Co-Editor

Dr Rberta James SIGN Programme Lead; Co-Editor

Pressr Jhn Kinsella Professor and Head of Academic Unit of Anaesthesia, Pain and Critical

Care Medicine, University of Glasgow

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Abbreiatins

CDD cre discharge dcument

CHI Cmmunity Health Index number

DD discharge dcument

EDD extended discharge dcument

GmC General Medical Cuncil

GP general practitiner

ICD-10 The Internatinal Statistical Classiicatin Diseases and Related Health Prblems, tenth

reisin

IDD immediate discharge dcument

oPCS-4 oice Ppulatin Censuses and Sureys classiicatin surgical peratins, urth reisin

PAS patient administratin system

SIGN Scttish Intercllegiate Guidelines Netwrk

SNomED-CT The Systematised Nmenclature Medicine Clinical Terms

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Reerences

1. General Medical Cuncil. Gd Medical Practice Guidance r dctrs. Lndn, 2009

2. Scttish Intercllegiate Guidelines Netwrk (SIGN). Interace between the hspital and the cmmunity. TheImmediate Discharge Dcument. Edinburgh: SIGN, 1996 (SIGN publicatin number 5).

3. Scttish Intercllegiate Guidelines Netwrk (SIGN). The Immediate Discharge Dcument. Edinburgh: SIGN, 2003(SIGN guideline number 65).

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SBN 978 1 905813 89 6

www.sign.ac.uk

www.healthcareimprovementscotland.org

Edinburgh Office | Elliott House | 8-10 Hillside Crescent | Edinburgh | EH7 5EATelephone 0131 623 4300 Fax 0131 623 4299

Glasgow Office | Delta House | 50 West Nile Street | Glasgow | G1 2NPTelephone 0141 225 6999 Fax 0141 248 3776

The Healthcare Environment Inspectorate, the Scottish Health Council, the Scottish Health Technologies Group, the ScottishIntercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium are key components of our organisation.

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