[The Importance of High Quality Discharge Letters: An Empirical Investigation]. / Die Bedeutung qualitativ hochwertiger Entlassbriefe: Eine empirische Untersuchung.

INTRODUCTION: The discharge letter is part of the discharge management. This study empirically examines the quality of discharge letters after a stay in a psychiatric/psychosomatic clinic using a self-developed code list. Suggestions are made for the creation and structuring of high-quality discharge letters that provide information to practitioners and institutions that should help in the seamless further treatment of patients. METHOD: Different aspects of the social-psychiatric and social-medical assessments in 50 discharge letters were evaluated by 2 raters each; in case of disagreements in evaluation, a consensus was reached. RESULTS: The average time between discharge from hospital and completion of the discharge letter was 22.4 days (median: 15.0 days). In 18% of cases, the letter of discharge was available at the time of discharge and in 14% within one week. In 24% of cases, the letter of discharge was only available after 27 days or longer. In 97.5% of the cases, the medication was completely listed, but in 52% of the cases, there was no information on further medical treatment by the specialist. When further treatment was recommended (n=10, e. g. day clinic or PIA), it was initiated in only three cases. At the time of admission, 28 patients had a job. Information on the employment status of 11 patients was missing. Information on the ability to work at the time of admission was complete in 44% and incomplete in 20%. At the time of discharge, seven patients were able to work, 19 were incapacitated and information on work ability was missing in the discharge report of 24 patients. CONCLUSION: A high quality discharge letter contains clear formulations, is structured, contains only relevant information and a separate chapter "Therapy recommendations/recommendations for further action". Electronic discharge letters with automated inclusion of examination findings/assessments save time and money during preparation and reading.

[Development of an instrument to measure stress conditions in patients with intellectual disabilities and psychiatric disorders: SEAGB-questionnaire]. / Skala zur Erfassung von Anspannungszuständen bei Menschen mit Intelligenzminderung: SEAGB-Fragebogen.

AIM: Stress conditions in patients with intellectual disabilities and psychiatric disorders are among all factors the most disabling in their quality of life. We aimed to develop a self-rating and third-person rating instrument verifying the effect of psychiatric and psychotherapeutic treatments in these patients. METHODS: First, we asked 150 caregivers of residential facility for patients with intellectual disabilities and psychiatric disorders to define 20 words, which describe stress conditions most accurately. Secondly, out of the list of collected words, two independent observers (neurologist, Germanist) defined subgroups, to which the words could be referred. Out of the most frequent subgroups, a questionnaire was developed in order to measure the expression of a target symptom. RESULTS: Out of 150 surveyed persons only 40 caregivers participated in the study with resulting 680 words defining stress condition in mentally disabled patients. Out of these, 31 words were excluded by observer A and 30 words by observer B, because according to their assessment, the words did not correctly cover the term 'stress condition'. Out of the remaining words, 13 subgroups were worked out. Exclusion of subgroups with less than 15 words in the development of the questionnaire resulted in following categories: (1) auto-aggression; (2) externalized aggression; (3) verbal aggression (4) isolation; (5) (motoric) restlessness; (6) autonomic changes; (7) emotional changes; (8) behavioral changes. For self- and third-person rating, a Likert scale was introduced, for self-rating, answers were visually supported with symbols. CONCLUSIONS: The development of an instrument to measure stress conditions in these patients is important for the improvement of therapies. Such an instrument for the measurement of psychological, social or medical therapy effects allows disentangling efficient strategies improving the patients' quality of life, as the assessment can be quickly integrated during a hospital intervention.