Helge Garåsen The Trondheim Model - NSDM

Summary
Study I
Background
Optimal care of patients is dependent on good professional interaction between general
practitioners and general hospital doctors, and this collaboration is mainly based upon the
quality of the written communication. The main objectives of study I were to evaluate the
quality of the written communication between physicians, the description of follow-up
responsibility and to estimate the number of patients that could have been treated at primary
level instead of in a general hospital.
Methods
The sample of study I comprised referral and discharge letters for 100 patients above 75 years
of age hospitalised at the orthopaedic, pulmonary and cardiological departments at the city
general hospital in Trondheim. The assessments were done using a Delphi survey with two
expert panels each with one general hospital specialist, one general practitioner and one
public health nurse using a standardised evaluation protocol with a visual analogue scale
(VAS) from one to eight. The panels assessed the quality of the description of medical
history, signs, medication, ADL, network, need for care and the level of benefit gained from
general hospital care.
Results
In study I information in referral letters on medical history, signs and medications were
assessed to be of high quality in 39 %, in 56 % and in 39 %, respectively. The corresponding
information assessed to be of high quality in discharge letters were for medical history 92 %,
signs 55 % and medications 82 %. Only half of the discharge letters had satisfactory
information on ADL. Some two-thirds of the patients were assessed to have had large health
benefits from the general hospital stay in question. One of six patients could have been treated
without a general hospital admission. The specialists assessed that 77 % of the patients had
had a large benefit from the general hospital admission; however the general practitioners
assessment was only 59 %. One of four of the discharge letters did not define who was
responsible for follow-up care.
Conclusions Study I
Both referral and discharge letters lack vital medical information, and referral letters to such
an extent that it might represent a health hazard for the patients. Health professionals at
7