TY - JOUR T1 - Making hospital discharge safer for frail older patients JF - British Journal of General Practice JO - Br J Gen Pract SP - 276 LP - 277 DO - 10.3399/bjgp20X709949 VL - 70 IS - 695 AU - Rachel Ann Spencer Y1 - 2020/06/01 UR - http://bjgp.org/content/70/695/276.abstract N2 - Hospital discharge represents one of the greatest challenges in interorganisational relationships in health care and can lay bare the potential failings of a healthcare system. The peri-discharge period is a risky time in a frail older patient’s journey and clear communication is key to a safer discharge experience. Communication across the interface has been identified by the James Lind Alliance as one of the top three priorities for primary care patient safety.1 There are three settings (angles) for the people involved in discharge: hospital staff, primary/community care staff, and patients/carers who are going home — and all parties clearly want to communicate as effectively as possible. As there are three angles, this can be conceptualised as a communication triangle.The burden of care in our healthcare system is widely acknowledged to have been shifting towards frail older patients. These patients have the highest risk of error and harm during care transitions2 because of multimorbidity, polypharmacy, and collapse of social networks. Research into discharge error and harm often focuses on this cohort though there are many other vulnerability factors, such as social deprivation, language barriers, and mental health problems. Safer discharge for an ever-increasing frail population against a background of increasing health inequality is complex, but may be addressed according to the angles of the communication triangle.Tensions are writ large in the literature related to intra- and interprofessional communication at the interface. Although GPs seldom report patient safety incidents related to discharge, when they do, communication problems are a key cause (21% of reported incidents, 27% of which are related to the interface).3 The Royal College of Physicians, the Scottish Intercollegiate Guidelines Network, and the Professional Record Standards Body have done much to improve the quality of discharge summaries.4–6 … ER -