Abstract
BackgroundThere is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge.MethodsThe Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance.ResultsIneffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change.ConclusionsThis study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-389) contains supplementary material, which is available to authorized users.
Highlights
There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs
We found that ineffective handovers that lead to patient readmissions are caused by poor information exchange, poor coordination of care and poor communication between hospital and primary care providers, and between care providers and patients
Our findings demonstrate the existence of a large number of determinants foreffective discharge that underscore the complexity of the discharge process
Summary
There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. Continuity of care at patient discharge from the hospital is a critical aspect of high quality patient care [2,3]. Incomplete or incorrect information and communication errors between hospital care providers and the multiple receiving parties often increase the chance of adverse events. These may lead to life threatening situations, avoidable treatments, unplanned re-hospitalisations [5,6], and extra costs [7,8,9]
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