Discharge Summary

Discharge Summary Template

This is a discharge template - use parts of it as necessary!

Course in hospital:

The following is an Issue-based course in hospital:

1) Primary Diagnosis:

2) Other MEDICAL ISSUES (issue and plan):

- A Fib

-NSTEMI/MI

- CHF

- DVT/PE

-Pneumonia

3) INCIDENTAL FINDINGS:

Please see the imaging section, where imaging reports are available as part of this discharge summary.

[Incidental Thyroid Nodule]

You have been found to have a thyroid nodule, this requires follow-up, we request that you please see your family physician within 2 weeks, such that this can be addressed with a referral to either head and neck surgery, or an endocrinologist for appropriate testing, or both. It is quite important that you please follow-up on your thyroid nodule.

[Incidental Lung Nodule]

You have been found to have a lung nodule, this requires follow-up, we request that you please see your family physician within 2 weeks such that this can be addressed with a referral to either respiratory medicine, or another physician, as required for additional appropriate testing. It is quite important that you please follow-up on your lung nodule.

[Follow-up Plan - ALL PATIENTS]

Follow-up Plan:

For ALL of our Patients - Family Doctor Follow-up after being in hospital:

For all of our patients, because you have recently been to hospital, we request that you please follow-up with your family physician within 1-2 weeks of discharge.

Please call your family physician's office and/or virtual visit and book an appointment to be seen in follow-up (in-person or virtual visit). If you do not have a family physician, please obtain a family physician. If you do not have a family doctor - please call: phone at 1-800-445-1822, Monday to Friday, 9am to 5pm. See website: https://www.ontario.ca/page/find-family-doctor-or-nurse-practitioner

In the interim, please see a walk-in clinic/Virtual Clinic or In-Person within 1-2 weeks to ensure that you are clinically stable, and there are no outstanding issues, and if at the discretion of the physician, you require, then you may be needing some additional testing such as blood work.

**If you feel as if you are experiencing a medical emergency - call 911 and/or return to the hospital if you are feeling unwell. **

[Medical Illness]

Your primary reason for admission to hospital was:

[STROKE]

For stroke treatment and prevention, you have been started on the following agents:

[option 0 - Single Antiplatelet]

You have been started on a SINGLE antiplatelet - for TIA or minor stroke: You have been started on Aspirin 81mg daily. If you experience any serious bleeding please seek immediate medical attention. For additional information on Antiplatelet medications, and what to expect about the possibility of bruising or minor bleeding, please visit the Heart and Stroke website at: https://www.heartandstroke.ca/heart/treatments/medications/antiplatelet-medications

[option 1 - DAPT 3 Weeks then Clopidogrel]

You have been started on - DUAL antiplatelet therapy for TIA or minor stroke: You have been started on Aspirin 81mg daily and Clopidogrel (also called PLAVIX) 75mg daily - for a Total of 3 weeks. Please discontinue ASA at the end of 3 weeks and continue to take Clopidogrel (PLAVIX) 75mg indefinitely. If you experience any serious bleeding please seek immediate medical attention. For additional information on Antiplatelet medications, and what to expect about the possibility of bruising or minor bleeding, please visit the Heart and Stroke website at: https://www.heartandstroke.ca/heart/treatments/medications/antiplatelet-medications

[option 2 - DAPT 3 Weeks then ASA]

You have been started on - DUAL antiplatelet therapy for TIA or minor stroke: You have been started on Aspirin 81mg daily and Clopidogrel (also called PLAVIX) 75mg daily - for a Total of 3 weeks. Please discontinue Clopidogrel (PLAVIX) at the end of 3 weeks and continue to take ASA 81mg indefinitely. If you experience any serious bleeding please seek immediate medical attention. For additional information on Antiplatelet medications, and what to expect about the possibility of bruising or minor bleeding, please visit the Heart and Stroke website at: https://www.heartandstroke.ca/heart/treatments/medications/antiplatelet-medications

[option 3 - DAPT 3 months then Clopidogrel]

You have been started on - DUAL antiplatelet therapy for symptomatic, severe intracranial atherosclerosis. Please continue to take aspirin 81 mg p.o. daily, along with Clopidogrel (also called PLAVIX) 75 mg p.o. daily, together for a total duration of 3 months. After 3 months, continue on Clopidogrel (also called PLAVIX) 75 mg orally daily. If you experience any serious bleeding please seek immediate medical attention. For additional information on Antiplatelet medications, and what to expect about the possibility of bruising or minor bleeding, please visit the Heart and Stroke website at: https://www.heartandstroke.ca/heart/treatments/medications/antiplatelet-medications

[option 4 - DAPT 3 months then ASA]

You have been started on - DUAL antiplatelet therapy for symptomatic, severe intracranial atherosclerosis. Please continue to take aspirin 81 mg p.o. daily, along with Clopidogrel (also called PLAVIX) 75 mg p.o. daily, together for a total duration of 3 months. After 3 months, continue on Aspirin 81 mg orally daily. If you experience any serious bleeding please seek immediate medical attention. For additional information on Antiplatelet medications, and what to expect about the possibility of bruising or minor bleeding, please visit the Heart and Stroke website at: https://www.heartandstroke.ca/heart/treatments/medications/antiplatelet-medications

[option 5 - Apixaban]

You have been started on - Apixaban (also called ELIQUIS) (LU code 448) You have been started on apixaban, a twice daily oral anticoagulant drug, for stroke prevention in atrial fibrillation. The standard dose is 5mg twice daily. Good compliance is essential for the drug to be effective. While taking apixaban, renal function should be monitored regularly (at least several times a year) and additionally when clinically indicated. Apixaban should be used at a reduced dose of 2.5mg BID if 2 out of 3 of the following criteria are present: Age>80; wt<60kg and creat >133umol/L. Apixaban use is not recommended if eGFR is <25 ml/min …and your eGFR is……

For additional information on Anticoagulants, and what to expect about issues such as side-effects, please refer to the following Heart and Stroke website address at: https://www.heartandstroke.ca/heart/treatments/medications/anticoagulants

[option 6 - Rivaroxaban]

You have been started on - Rivaroxaban (also called XARELTO): (LU code 435) You have been started on rivaroxaban, a once daily oral anticoagulant drug for stroke prevention in atrial fibrillation. The standard dose is 20mg daily. Good compliance is essential for the drug to be effective. While taking rivaroxaban, renal function should be monitored regularly (at least several times a year) and additionally when clinically indicated. Rivaroxaban should be used at a reduced dose of 15mg daily if eGFR is 30-49ml/min. Rivaroxaban use is not recommended if eGFR is <30 ml/min …and your eGFR is……

[option 7 - Warfarin]

You have been started on WARFARIN as a blood thinner, it is quite important that you take your dose daily for this medication. he use of warfarin should not interfere with a healthy diet. However it is important not to have large day-to-day variations in the amount of vitamin K which is found in foods such as kale, broccoli, spinach, turnip greens, Brussels sprouts. Therefore it you can eat any of these things however your diet must be consistent in the amount of leafy green vegetables such that the amount of vitamin K is stable because vitamin K reduces the efficacy of warfarin. For warfarin, your target INR is [FILL TARGET INR] - with a range of [FILL RANGE] -the INR, known as the international eyes normalized ratio, is a way of expressing how thin your blood is, and therefore measurement is required to make sure that your blood is adequately thin while on this medication. When initially starting on this medication he takes regular blood work, measuring the INR on a daily basis even, as it becomes more stable, weekly or a couple of times monthly is all that is needed to ensure that your INR is within the therapeutic limit.

[STATIN AGENT]

You have been started on a statin agent: [STATIN]. We request that you follow-up with your family doctor with re-assessment and repeat bloodwork for liver/lipid profiles and CK in 3 months then annually. For Cholesterol and post-stroke risk modification: Your targets are a total cholesterol <4.0 and LDL <2.0.

Treatment with medications such as statins can cause common complaints such as muscle pain. You may feel pain as soreness, tiredness or weakness in your muscles. In general the actual risk of developing muscle pain as a result of taking a statin is about 5% or less. Studies have found that people stop taking this medication up to 30% because of muscle aches even when it was not due to this medication and they were on a placebo medication. Nonetheless, if you are having severe muscle aches, muscle pain, please see her physician for additional follow-up. Very rarely statins can cause a life-threatening illness, muscle injury called rhabdomyolysis, which can cause liver damage, kidney failure and even death. The risk of this very serious side effect is extremely low, it is a few cases per millions of patients, however this is a known risk and you should be aware of it. Liver damage or injury can occur with statin therapy, however this is again extremely rare, which is why we recommend you follow-up with your family physician in approximately 3 months for follow-up and blood work as outlined above.

[ACE-I / ARB / Diuretics]

Please see your family doctor - suggest monitoring of electrolytes and Creatinine when started on medications belonging to the class of ACEi (ACE Inhibitors)/ARBs (Angiotensin receptor blockers) and diuretics ("water pills").

Investigations pending - the following tests are pending:

Labwork (A1C, Lipid Profile)

Hypercoaguable screening

Auto-immune serology

CT angiogram

MRI brain

MR angiogram

MR venogram

MR vessel wall imaging

Carotid dopplers

Transcranial dopplers for microemboli detection

TTE (Trans-thoracic Echocardiogram)

TEE (Trans-esophageal Echocardiogram

24-48 hour Holter monitoring

Prolonged Holter monitoring

Overnight Polysomnogram (sleep study)

EEG

EMG/NCS

Brain SPECT

Driving information:

[option 1]

At this time, you do not require reporting to the ministry of transportation, using the medical condition report (as outlined as of July 2018 regulations) - Because you do not have significant motor/physical impairment, cognitive impairment or visual field impairment - If you use corrective vision for driving, please ensure that you use corrective vision when driving. Should your medical status change or you have any additional or new medical problems a physician needs to please reassess you for driving, and you should hold driving (i.e. Do not Drive) until that assessment has been completed. If you have return of any symptoms that you had like those that caused your admission please see a physician, and you are not to drive for 1 month until reassessed by a physician.

[option 2]

You are instructed not to drive for 1 month, until reassessed by a physician. You may be seen at a hospital clinic or make an appointment to see your family doctor within 1 month or at the one-month mark, please see family physician before resuming driving.

[option 3]

You are instructed not to drive, you have been reported to the ministry of transportation, as per the legal requirement to report patients with stroke who have any of motor or physical impairment, cognitive impairment or visual field impairment, or at risk of stroke, or if there is concern by the physician team that the patient is at risk of a motor vehicle collision or safety of self or others. Please do not drive until you are reassessed at the prevention clinic. Once you have received your forms from the ministry of transportation, and you are medically stable, any physician including family physician, or stroke physician at the stroke prevention clinic or TIA clinic can complete your forms.

Follow-up plan:

For ALL of our Patients - Family Doctor Follow-up after being in hospital:

For all of our patients, because you have recently been to hospital, we request that you please follow-up with your family physician within 1-2 weeks of discharge.

**If you feel as if you are experiencing a medical emergency - call 911 and/or return to the hospital if you are feeling unwell. **

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