"V good acute admission, some learning about discharge letters, fab admin staff"

Thank you to staff at St James's A&E, JAMAA and J27. I was admitted for about 24 hours after an acute illness wobbled my long term conditions, and while everywhere was clearly very busy, and waits were much longer than normal, all the staff were absolutely brilliant - the doctor and nurse (Lisa) in JAMAA particularly good.

At times of high pressure it's easy for staff to get niggly with each other, and this is visible to patients and leaks out in their care too, but I didn't hear or see anything except good spirited support for each other.

The nurses in J27 were especially kind - despite being in a very difficult situation trying to deal with an agitated and confused patient who had pressure of speech and continually talked at them. They managed to be kind to him and also to let the other patients know that they knew it was difficult for them too.

The only small but significant thing that went a bit awry was my discharge letter. The poor Jr Dr who had to write it clearly had a huge number of tasks to try to get done asap. He had a very quick chat with me - if he'd said "I just need to write the discharge letter - can you give me a summary? " I could have been more useful to him, I think. As it was, the story in the letter was slightly backwards, but - more importantly - the summary opened with some obs, including 'CRP 90'.

Fortunately I read the letter when it was handed to me, I know what CRP means, and I was confident that my CRP was not 90 - though I also knew that if it was then I shouldn't be going home without antibiotics! Even more fortunately, the ward manager/administrator (apologies for lack of clarity) is really approachable. I mentioned it to her and asked if there was any way we could have it checked - and she immediately said she would check it herself. The computers were running slowly and she could have fobbed me off with the kind of 'reassurance' that is often handed out to patients ("I'm sure if the Drs were worried they'd have told you. Your GP will follow up if they need to.... etc") but she persevered and got my lab results. The 'CRP 90' should have been 'eGFR over 90'. My actual CPR was less than 5 (normal). That's a huge difference!

Had I not read my discharge letter, felt confident to question it, and met a helpful response, my GP would have been really concerned on receiving it. No doubt some combination of me having repeat tests / starting unnecessary antibiotics / GP and hospital staff playing phone-message tennis, would have arisen. (My GP can't access the lab results at Leeds, but even if they could, it's time they need to spend elsewhere). The outcome of the mix up could have been anything from wasted clinician time to an adverse reaction to unneeded antibiotics.

The Jr Dr who wrote the discharge letter is not to blame. Human accuracy and reliability when transcribing is at best poor and often terrible. As a software developer, I shudder at the thought that we are still asking HCPs to transcribe lab results and observations. Ideally lab results should be (selectively) included by a click / tick, but I work enough with the NHS to understand the huge challenges in IT at present.

As an interim measure, can I suggest that where results are being transcribed in to notes or letters, they should always, without exception, come with their units. "90" is not anything - eGFR is (gt than) 90 ml/min/1. 73m2, and CRP is 90 mg/L. By always including units, we give our brains a second chance to spot the error. On reading back - by the writer or the recipient - "CRP 90 ml/min/173m2" would stand out as an error, and give a clue as to how it arose. Some units are more common, but many do differ. Some errors will be obvious because of the size of the numbers involved. The combination of the two is the best insurance against the worst case scenario - plausible, wrong, data that changes actions.

There is often a sense in the NHS that the only mistakes that matter are the ones that 'miss' important disease, but direct and indirect harms also occur as a result of over treatment and over investigation. It's just as important to not attribute an infection to a patient who doesn't have one as it is to correctly diagnose an infection where it is present. The combination with the incorrect summary story - which said that I'd had viral D&V, when actually I'd had D&V that I was confident was a complication of my LTCs and not an infection - could have triggered 'care' that would actually have been 'harm'.

Fortunately, in this case, because the ward manager/administrator was so helpful, we averted any problems, but I can't imagine that this is an exceptional situation. Until such time as you have fit-for-purpose software for Jr Drs doing discharge letters, the tiny extra 'work' involved in always including units with numerical results will be repaid in reduction of the less frequent but bigger task of untangling mis-transcribed results. No doubt the helpful ward manager/administrator also had a long list of pressing tasks that were delayed while she helped me - though she never gave me the impression that I was wasting hers, and for that, in particular, I'm very grateful!