Emergency Care discharge summaries

To support the delivery of high quality care, there's an increasing need to share information more efficiently and consistently across health and social care. The Transfer of Care Initiative aims to improve patient care by promoting and encouraging the use of professional and technical document standards.

• improved patient care and safety due to the availability of complete, accurate and timely information
• reduction in the risk of missing or inappropriate critical clinical information
• reduction in costs by removing the administrative task of correcting information and eliminating paper exchange

Every year millions of patients attend an Emergency Care setting, so it is important that GP Practices receive accurate and timely information. Consistent information sharing at the point of transfer has been shown to improve patient care and in the context of Emergency Care will help alleviate winter pressures.

The Emergency Care Discharge summary must currently be issued to GP practices within 24 hours following a patient's A&E attendance. To support this information sharing the establishment of a national standard, fully structured, coded electronic message to convey information from an Emergency Care department to a GP Practice is in progress. As a result, the NHS Standard Contract (NHS England Standard Contract Technical Guidance) section 39.22 states that from 1 October 2018 the Emergency Care discharge summary must:

• conform to the clinical record standard headings
• be sent nationwide (in and out of catchment area within England) using any direct electronic transmission including proprietary solutions, except email. Email will no longer be allowed
• use a nationally specified structured message capable of carrying narrative, SNOMED CT and dm+d encoded information

The Professional Record Standards Body (PRSB) has published the PRSB Standards for the Structure and Content of Health and Care Records which replaces the Academy of Medical Royal Colleges publication ‘Standards for the Clinical Structure and Content of Patient Records’ published in 2013. 

The PRSB standards have been updated to reflect current professional practice and incorporate new or changed structured content resulting from the development of detailed transfer of care standards. They have been developed with input from thousands of professionals from all health and social care specialties, carers and people who access services. They agreed what information is essential to share in order to provide timely, high-quality care efficiently that is well-coordinated and meets an individual’s needs.

This is the first major release since 2013 and PRSB has produced guidance, FAQs and other materials to help organisations and system suppliers replace previous versions of the standards in their information systems. 

The PRSB Emergency Care Discharge standard details the headings that must be implemented in Emergency Care Discharges by 1 October 2018.

Providers are reminded that, as detailed in the NHS England Standard Contract Technical Guidance, from 1 October 2018, you must align your Emergency Care discharges with the nationally published specification.

Transfer of Care documents must be sent within England (in and out of catchment area) by any direct electronic transmission including proprietary solutions, except email, using a structured and coded message specification capable of carrying SNOMED CT encoded diagnosis, procedures, allergies and dm+d encoded medication information.

NHS Digital has adopted Fast Healthcare Interoperability Resources (FHIR) based structured document standards for Transfer of Care. Download the Transfer of Care FHIR specifications

The Transfer of Care FHIR messages will use the ITK3 (Interoperability Toolkit) specification.