Excerpt from "Hospital Clinical Documentation Guidelines"

A discharge summary is arguably one of the most critical documents in ensuring patient safety and continuity of care after a hospital admission. Its primary purpose is to provide the patient's General Practitioner (GP) with a concise yet comprehensive summary of the hospital course. A frequent and dangerous gap in these summaries is the failure to clearly delineate between medications that were stopped, started, or simply continued. This can lead to significant prescribing errors in the community. For example, if a hospital doctor stops a patient's long-term medication but fails to highlight this in the summary, the GP may inadvertently restart it, potentially causing patient harm. Furthermore, the follow-up plan must be explicit and actionable. A vague instruction such as "follow up with GP" is unhelpful. A high-quality summary provides specific directions, for instance, "We kindly request that you check the patient's renal function in two weeks' time, as the new medication can affect the kidneys." This transforms the document from a simple historical record into a vital tool for future patient management. The timely delivery of this summary, ideally within 24-48 hours of discharge, is also a key performance indicator for our hospital trust, as delays are known to be a factor in preventable readmissions.

Question: According to the text, what is a major risk associated with a poorly written discharge summary?

Scenario: You will hear a junior doctor dictating a brief admission note for a patient.

Task: Complete the discharge summary notes below. Write one or two words for each gap.