Table 2 Summary of scoping review findings

1. Mode, timing and medium of letters

Discharge letters are not always received by physicians in an adequate timeframe. Quality impacts and ethical and legal implications of technological interventions and affordances of electronic communication need further research.

2. Letter content

Discharge letters do not always contain sufficient detail relative to content components considered important to recipients e.g. diagnosis. Reasons for content variation, despite availability of guidelines, needs further research as well as better understanding of content items and details important to those involved in discharge communication.

3. Patients receiving letters

Patients receiving discharge letters, where there is no identified risk of this being harmful, is currently considered to be good practice. However, patients do not always receive letters. Reasons for this inconsistency and variation was unclear and needs further research. The format of patient letters vary, and include patient personalised letters and receiving a copy of the letter sent to the GP. The implications of these differing letter forms in terms of cost-benefit analysis and patient outcomes are indeterminate and require further research.

4. Letter form

A variety of letter forms may be used for discharge communication, such as dictated letter forms and structured discharge summary templates. Future research should assess feasibility and implications of interventions for integrating more standardised systems.

5. Letter authorship

There are potential issues with junior doctors and inexperienced practitioners producing discharge letters without adequate support. Support interventions such as training may increase discharge quality. Further research is needed to design, implement and evaluate feasible and sustainable training and support interventions.

6. Letter quality related to safety implications

Poor quality of discharge communication can pose risks to patient safety. Vulnerable groups such as those with medically complex needs, the elderly, those with low health literacy, and those with a lack of social or family support may be particularly at risk. Further research is needed to understand the needs of these groups and how risks to patient safety can be reduced through improved communication quality.

7. Medication information

Adequate details regarding medication information, particularly changes to medication, are not always included in discharge letters or clear to recipients. Further research should look at feasible and sustainable interventions for improving communication of medication information.