Effective acute care handover to GP: optimising the structure to improve discharge documentation.

Time and resource constraints have often led to the use of assessment records as discharge communications from acute and emergency departments. However, whether this addresses the primary care needs has not been demonstrated. This study examined the optimal structure that can impart key discharge information effectively using feedback from general practitioners (GP). We implemented an electronic assessment template that focused on the most relevant headings. Prespecified process measures were examined and qualitative thematic analysis of free-text comments from GP surveys were conducted to optimise the document. Our findings suggest that the structure of a discharge summary can influence the quality of information, users' compliance and readers' perceptions of the length of the letter.

Potential costs of B-type natriuretic peptide for the identification of people with heart failure in primary care in Scotland - a pilot study.

BACKGROUND AND AIMS: The utility of B-type natriuretic peptide as a screening test for heart failure has been proven in a number of clinical trials. The aims of this study were to assess the utility of the measurement of B-type natriuretic peptide in a 'real life' setting and to estimate the potential costs of implementing its use in primary care in Scotland. METHODS AND RESULTS: Eight general practitioner practices with a combined population of approximately 62,000 were invited to participate. During the 9-month study period, 82 samples for B-type natriuretic peptide measurement were requested. The negative predictive value for B-type natriuretic peptide was 96.9%. Compared with electrocardiography, B-type natriuretic peptide reduced the need for echocardiography by 308 tests per million population per year. The estimated cost of implementation in Scotland is approximately £220,000 per annum, equating to £64.93 per patient correctly diagnosed with heart failure, with a potential saving in echocardiography of £110,800. CONCLUSION: In this pilot study, measurement of plasma B-type natriuretic peptide in a 'real life' setting in primary care had a similar sensitivity, specificity and negative predictive value to that observed in trial populations. B-type natriuretic peptide aids early diagnosis of heart failure in primary care and may help to facilitate prompt introduction of evidence based therapies to modify patient outcomes. The costs of measuring plasma B-type natriuretic peptide in suspected cases of heart failure are modest, and its use would increase the diagnostic capacity of primary care if supported by local cardiology services.

Defaulted appointments in general practice.

In a two-month study in an urban general practice of eight partners, 11.7 per cent of patients failed to attend for their appointments. Defaulters were younger than a control group of attenders, but the male to female ratio was almost identical. Annual consultation rates for defaulters were slightly lower than controls. Return visits had a default rate of 18 per cent and there was a strong statistical correlation between how and when an appointment was made and the default rate, with a maximum default rate of 19 per cent if the appointment was made between one to two weeks in advance. There was a significant difference in default rate between the partners (range 7.2-14.6 per cent) and the default rate was lowest on Mondays (9.7 per cent) and highest on Fridays (14.9 per cent). The majority of the defaulters had only defaulted once in the previous 12 months. These findings have important implications when planning an appointment system and asking patients to return for follow-up.