P18.03 * PATIENT FEEDBACK INTERVIEWS FOR DEVELOPMENT OF DISCHARGE PROCEDURES

Abstract

BACKGROUND: Discharging patients from the hospital is a complex process. A survey revealed that about one-third of dismissed neurosurgical patients did not have a concluding consultation (32 %), an accurate discharge medication list (28 %), or an updated information on relevant symptoms requiring a follow-up (28 %). Improving the quality of hospital discharges may prevent re-hospitalization and has the potential to improve the quality-of-life for patients. PURPOSE: To highlight the priorities and experiences of patients and next of kin at discharge after intracranial neurosurgery in order to improve discharge procedures with incorporation of major key elements. METHODS: Direct staff-to-patient feedback discussions were based on a semi-structured interview template presented to patient discharged within two month after intracranial neurosurgery. Patients and next of kin were grouped with independent interviewers and instructed to elaborate lists of priorities regarding 1) good-experience events, 2) things that went wrong, 3) experience of discharge process, 4) reconciliation with discharge, 5) quality of post-discharge care. RESULTS: The response of patients and next of kin could be categorized into three main themes: 1) in-hospital information and patient involvement in the process of discharge, 2) post-discharge support and plans, 3) reconciliation with discharge. Typical discontent focused on not to be informed of test results (i.e. simple blood pressure measurements), being asked the same questions over again, and lack of advise concerning treatment opportunities. Also more involvement of next of kin and a follow-up consultation at about two weeks after discharge was warranted. In addition, patients felt that provisions for follow-up care were often inadequate. PERSPECTIVES: Responses from the interviews suggest that development of discharge checklists may favorably focus on 1) univocal in-hospital information about procedures, tests and medication, 2) involvement of patient and next of kin in individualized discharge plans, 3) determination of the need and site of post-discharge care. Development of personalized discharge checklists may improve patient outcome and diminish rate of re-hospitalization.