Quality statement 3: Communication with primary care

Quality statement

Adults admitted to hospital with a myocardial infarction (MI) have the results of investigations and a plan for future treatment and monitoring shared with their GP.

Rationale

People with an MI have cardiac investigations in hospital – clear communication of these results to primary care in a discharge summary ensures that people receive the right treatment after they leave hospital. Other key information to be shared with the GP includes future treatment, including incomplete drug titrations, plans for further revascularisation procedures and plans for antiplatelet and anticoagulant treatment. A clear plan for monitoring blood pressure and renal function ensures that people are on the correct drug dose after they leave hospital. Finally, it is also important for GPs to know that people have been referred for cardiac rehabilitation to encourage them to attend.

Ensuring that this information is included in a discharge summary will improve clinical outcomes, patient experience and continuity of care between primary and secondary or tertiary care services. This is especially important for people who have had hospital treatment for an MI outside of their local area.

Quality measures

Structure

Evidence of local arrangements to ensure that adults admitted to hospital with an MI have the results of investigations and a plan for future treatment and monitoring shared with their GP.

Data source: Local data collection.

Process

a) Proportion of discharges from hospital after an MI where the patient had the results of investigations shared with their GP.

Numerator – the number in the denominator where the patient had the results of investigations shared with their GP.

Denominator – the number of discharges from hospital after an MI.

Data source: Local data collection.

b) Proportion of discharges from hospital after an MI where the patient had plans for future treatment and monitoring shared with their GP.

Numerator – the number in the denominator where the patient had plans for future treatment and monitoring shared with their GP.

Denominator – the number of discharges from hospital after an MI.

Data source: Local data collection.

Outcome

a) Readmission rates.

b) Rates of uptake and adherence to cardiac rehabilitation.

c) Patient experience of GP services.

Data source: National data on emergency readmissions within 30 days of discharge from hospital are available from the Health and Social Care Information Centre.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary and tertiary care services) ensure that adults discharged from hospital after an MI have the results of investigations and a plan for future treatment and monitoring shared with their GP.

Healthcare professionals include the results of investigations and a plan for future treatment and monitoring in the GP discharge summary for adults discharged from hospital after an MI.

Commissioners (clinical commissioning groups) commission services that provide GP discharge summaries for adults discharged from hospital after an MI. The GP discharge summaries should include the results of investigations and a plan for future treatment and monitoring.

What the quality statement means for patients, service users and carers

Adults who are admitted to hospital with a heart attack have a letter sent to their GP, which includes the results of any tests and a plan for treatment and monitoring in the future. This helps to make sure that people get the right treatment after they leave hospital and start a programme to improve their long‑term health (cardiac rehabilitation) as soon as possible.

Source guidance

  • MI – secondary prevention (2013) NICE guideline CG172, recommendations 1.3.2, 1.3.31 (key priority for implementation) and 1.6.1 (key priority for implementation)

Definitions of terms used in this quality statement

Results of investigations

People admitted to hospital with an MI may have several investigations of cardiac function while in hospital. These may include coronary angiography and should include assessment of left ventricular function. [Expert opinion]

Plan for future treatment and monitoring

A plan for future treatment and monitoring after an MI should include details of:

  • any further revascularisation procedures

  • any drug titrations that need to be completed by the GP

  • duration of antiplatelet treatment

  • duration of any anticoagulant treatment

  • blood pressure and renal function monitoring

  • referral for cardiac rehabilitation. [Expert opinion]