Stroke patients entering nursing home care: a content analysis of discharge letters

Objective: To examine the information contained in medical and nursing staff hospital discharge letters for stroke patients entering nursing home care. Design: A retrospective content analysis comparing case notes with discharge letters. Setting: Nottingham (UK) hospitals. Subjects: Thirty-eight stroke patients with a Barthel Activities of Daily Living Index score of less than 11/20 at three months post stroke who were discharged into a nursing home. Method: Patients' medical case notes and medical and nursing discharge letters were subjected to the same structured content analysis. The three key areas were: self-care ability (i.e. washing, dressing), nursing needs (i.e. diet, continence) and risk assessment (i.e. falls, pressure sores). Results: Discharge letters were least likely to provide information on risk assessments, for example only 14 (37%) documented the risk of pressure sores and 7 (18%) falls. Thirty discharge letters (79%) had information relating to self-care ability and nursing care, although a blanket term 'needs all care' was used to describe patient ability in 20 (66%) of these. Conclusion: The results demonstrate that the completeness and accuracy of information is often poor, doing little to enhance the continuity of care for patients who are transferred from hospital to nursing homes.