Discharge Communication Research Articles

Discharge Communication and the Achievement of Lifestyle and Behavioral Changes Post-Stroke in the Transitions of Care Stroke Disparities Study.

Objectives: This study identifies the association between patient perception of discharge education/resources and adequate transitions of care (ATOC) (i.e., patient achievement of at least 75% of recommended positive behaviors and activities within 30days post-stroke hospitalization). Methods: The analysis measured the association between sufficient discharge communication (SDC) (i.e., patient receipt of sufficient diet education, sufficient toxic habit cessation education, if applicable, and scheduled medical follow-up appointment) and ATOC within 30days post-discharge overall and by race/ethnicity [non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic] in the Transitions of Care Stroke Disparities Study (TCSD-S) (2018-2023). Results: In our sample (N = 1151, Average Age 64+/-14years, 57% Men, 54% NHW, 24% NHB, 23% Hispanic), 31% overall, as well as 22% of NHW, 43% of NHB, and 41% of Hispanics reported SDC. After covariate adjustment, patients reporting SDC had increased likelihood of accomplishing ATOC when compared to patients not reporting SDC overall (OR = 1.97; 95% CI: 1.42-2.74) and among NHW (OR = 2.76; 95% CI: 1.64-4.64) and NHB (OR = 2.29; 95% CI: 1.16-4.53). The association among Hispanic participants was not statistically significant. Conclusion: Our findings reinforce the importance of providing quality communication to patients to ensure a successful transition of care from hospital to home or rehabilitation facility.

Discharge communication during transitions from emergency care to home.

The healthcare system in Canada is overwhelmed and requires reform. Good discharge communication is a cornerstone of patient safety and quality care. In the Emergency Department (ED), good discharge communications means that patients leave with a clear understanding of their health condition, and the steps they need to take to continue their recovery at home. The fragmented nature of communication in the ED coupled with long wait times and high noise levels pose significant risks to the continuity of information exchange. Additional communication barriers arise for many patients due to a lack of control, language differences, low health literacy, and feelings of fear and uncertainty. Multiple interventions have been evaluated to improve ED discharge communication, but further work is needed to engage all end users in a theory-based approach. Addressing challenges related to successful discharge communication requires a multifaceted approach that includes improving institutional policies, adopting innovative co-designed interventions, and leveraging technology.

'You're Just Thinking About Going Home': Exploring Person-Centred Medication Communication With Older Patients at Hospital Discharge.

The hospital discharge process poses significant safety risks for older patients due to complexities in communication and coordination among stakeholders, leading to potential drug-related problems post-discharge. Adopting a person-centred care (PCC) approach in medication communication by healthcare professionals (HCPs) is crucial to ensure positive health outcomes. This study aimed to explore the practice of PCC in medication communication between older patients and HCPs during the hospital discharge process. We conducted a qualitative study using non-participatory direct observations of patient-HCP consultations during hospital discharge, followed by semi-structured interviews with observed patients and, when applicable, their informal caregivers. Data collection occurred from October 2020 to May 2021 at two Swedish hospitals. We gathered data using an observational form and audio-recorded all consultations and interviews. The data were analysed thematically using the systematic text condensation method. Twenty patients were included (median age: 81 years [range: 65-94]; 9 female) in observations and 13 of them participated in interviews. Two patients were accompanied by an informal caregiver during the interviews. Three main themes were identified: (1) The impact of traditional authoritarian structures, depicts power dynamics between patients and their HCPs, showing how traditional structures influence the practice of PCC in medication communication during hospital discharge; (2) Consultation timing and mode not on patients' terms, describes suboptimal times and settings for consultations, along with the use of complex language that hinders effective communication; and (3) Discrepancy in expectations of self-care ability, illustrates a mismatch between the self-care guidance provided by HCPs during hospital discharge and the actual needs and preferences of patients and informal caregivers. Medication communication between older patients and HCPs during hospital discharge is frequently inconsistent with the practice of PCC. Not only must HCPs improve their communication strategies, but patients and their informal caregivers should also be better prepared for discharge communication and encouraged to participate in their care. This involvement would give them relevant knowledge and tailor communication to their individual needs, preventing problems in managing their medications after discharge. An advisory group of six patients and/or informal caregiver contributors provided input on the study design, edited the consent forms, and helped develop the interview guide.

Impact of Early Admission Surveys on Physicians' Communication Skills on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores: A Quality Improvement Initiative.

Introduction Effective communication between doctors and patients is one of the 19 core questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Positive patient experiences, as reflected in HCAHPS scores, are associated with higher quality of care, reduced mortality, and fewer readmissions. These scores also influence a hospital's financial bonuses or penalties from the Centers for Medicare & Medicaid Services. Methods This quality improvement (QI) initiative evaluated how early surveys of patients' feedback on doctors' communication skills during admission impacted discharge communication scores. The approach involved promptly sharing patients' feedback with physicians and focusing on improving communication skills for those with less-than-perfect scores. Results This QI initiative involved 41 patients. By surveying patients early during admission and addressing communication issues for those with less-than-perfect scores, the percentage of patients achieving a perfect score on all survey questions increased from 18 (43.9%) at admission to 34 (82.9%) at discharge. The largest improvement was seen in perfect scores for doctors' explanations of patients' conditions, which rose from 59% at admission to 90% at discharge. Conversely, the increase in perfect scores for doctors' respectful treatment was smaller, rising from 88% at admission to 98% at discharge. Conclusion Surveying patients about their doctors' communication skills early in admission to identify those with less-than-perfect scores and improving communication for this group resulted in a 39% increase in satisfaction with doctors' communication.

Identifying Facilitators and Inhibitors of Shared Understanding: An Ethnography of Diagnosis Communication in Acute Medical Settings.

Communication is important in determining how patients understand the diagnostic process. Empirical studies involving direct observation of communication within diagnostic processes are relatively limited. This ethnographic study aimed to identify communicative practices facilitating or inhibiting shared understanding between patients and doctors in UK acute secondary care settings. Data were collected in acute medical sectors of three English hospitals. Researchers observed doctors as they assessed patients; semistructured interviews were undertaken with doctors and patients directly afterwards. Patients were also interviewed 2-4 weeks later. Case studies of individual encounters (consisting of these interviews and observational notes) were created, and were cross-examined by an interdisciplinary team to identify divergence and convergence between doctors' and patients' narratives. These data were analysed thematically. We conducted 228 h of observation, 24 doctor interviews, 32 patient interviews and 15 patient follow-up interviews. Doctors varied in their communication. Patient diagnostic understanding was sometimes misaligned with that of their doctors; interviews revealed that they often made incorrect assumptions to make sense of the fragmented information received. Thematic analysis identified communicative practices that seemed to facilitate, or inhibit, shared diagnostic understanding between patient and doctor, revealing three themes: (1) communicating what has been understood from the medical record, (2) sharing the thought process and diagnostic reasoning and (3) closing the loop and discharge communication. Shared understanding was best fostered by clear communication about the diagnostic process, what had already been done and what was achievable in acute settings. Written information presents an underutilised tool in such communication. In UK acute secondary settings, the provision of more information about the diagnostic process often fostered shared understanding between doctor and patient, helping to minimise the confusion and dissatisfaction that can result from misaligned expectations or conclusions about the diagnosis, and the uncertainty therein. A patient and public involvement group (of a range of ages and backgrounds) was consulted. They contributed to the design of the protocol, including the timing of interviews, the acceptability of a follow-up telephone interview, the development of the interview guides and the participant information sheets.

Assessing Patient Readiness for Hospital Discharge, Discharge Communication, and Transitional Care Management.

Discharge communication between hospitalists and primary care clinicians is essential to improve care coordination, minimize adverse events, and decrease unplanned health services use. Health-related social needs are key drivers of health, and hospitalists and primary care clinicians value communicating social needs at discharge. To 1) characterize the current state of discharge communications between an academic medical center hospital and primary care clinicians at associated clinics; 2) seek feedback about the potential usefulness of discharge readiness information to primary care clinicians. Exploratory, convergent mixed methods. Primary care clinicians from Family Medicine and General Internal Medicine of an academic medical center in the US Intermountain West. Literature-informed REDCap survey. Semistructured interview guide developed with key informants, grounded in current literature. Survey data were descriptively summarized; interview data were deductively and inductively coded, organized by topics. Two key topics emerged: 1) discharge communication, with interrelated topics of transitional care management and follow-up appointment challenges, and recommendations for improving discharge communication; and 2) usefulness of the discharge readiness information, included interrelated topics related to lack of shared understanding about roles and responsibilities across settings and ethical concerns related to identifying problems that may not have solutions. While reiterating perennial discharge communication and transitional care management challenges, this study reveals new evidence about how these issues are interrelated with assessing and responding to patients' lack of readiness for discharge and unmet social needs during care transitions. Primary care clinicians had mixed views on the usefulness of discharge readiness information. We offer recommendations for improving discharge communication and transitional care management (TCM) processes, which may be applicable in other care settings.

Co-designing discharge communication interventions for mental health visits to the pediatric emergency department: a mixed-methods study

BackgroundDischarge communication is essential to convey information regarding the care provided and follow-up plans after a visit to a hospital emergency department (ED), but it can be lacking for visits for pediatric mental health crises. Our objective was to co-design and conduct usability testing of new discharge communication interventions to improve pediatric mental health discharge communication.MethodsThe study was conducted in two phases using experience-based co-design (EBCD). In phase 1 (Sep 2021 to Jan 2022), five meetings were conducted with a team of six parents and two clinicians to co-design new ED discharge communication interventions for pediatric mental health care. Thematic analysis was used to identify patterns in team discussions and participant feedback related to discharge communication improvement and the Capability, Opportunity, Motivation, Behavior (COM-B) model was used to identify strategies to support the delivery of the new interventions. After meeting five, team members completed the Public and Patient Engagement Evaluation Tool (PPEET) to evaluate the co-design experience. In phase 2 (Apr to Jul 2022), intervention usability and satisfaction were evaluated by a new group of parents, youth aged 16–24 years, ED physicians, and nurses (n = 2 of each). Thematic analysis was used to identify usability issues and a validated 5-point Likert survey was used to evaluate user satisfaction. Evaluation results were used by the co-design team to finalize the interventions and delivery strategies.ResultsTwo discharge communication interventions were created: a brochure for families and clinicians to use during the ED visit, and a text-messaging system for families after the visit. There was high satisfaction with engagement in phase 1 (overall mean PPEET score, 4.5/5). In phase 2, user satisfaction was high (mean clinician score, 4.4/5; mean caregiver/youth score, 4.1/5) with both interventions. Usability feedback included in the final intervention versions included instructions on intervention use and ensuring the text-messaging system activates within 12–24 h of discharge.ConclusionsThe interventions produced by this co-design initiative have the potential to address gaps in current discharge practices. Future testing is required to evaluate the impact on patients, caregivers, and health care system use after the ED visit.

Improving patients’, carers’ and primary care healthcare professionals’ experiences of discharge communication from specialist palliative care to community settings: a protocol for a qualitative interview study

BackgroundPatients who have benefited from specialist intervention during periods of acute/complex palliative care needs often transition from specialist-to-primary care once such needs have been controlled. Effective communication between services is central to co-ordination of care to avoid the potential consequences of unmet needs, fragmented care, and poor patient and family experience. Discharge communications are a key component of care transitions. However, little is known about the experiences of those primarily receiving these communications, to include patients’, carers’ and primary care healthcare professionals. This study aims to have a better understanding of how the discharge communications from specialist palliative care services to primary care are experienced by patients, carers, and healthcare professionals, and how these communications might be improved to support effective patient-centred care.MethodsThis is a 15-month qualitative study. We will interview 30 adult patients and carers and 15 healthcare professionals (n = 45). We will seek a range of experiences of discharge communication by using a maximum variation approach to sampling, including purposively recruiting people from a range of demographic backgrounds from 4–6 specialist palliative care services (hospitals and hospices) as well as 5–7 general practices. Interview data will be analysed using a reflexive thematic approach and will involve input from the research and advisory team. Working with clinicians, commissioners, and PPI representatives we will co-produce a list of recommendations for discharge communication from specialist palliative care.DiscussionData collection may be limited by the need to be sensitive to participants’ wellbeing needs. Study findings will be shared through academic publications and presentations. We will draft principles for how specialist palliative care clinicians can best communicate discharge with patients, carers, and primary care clinicians. These will be shared with clinicians, policy makers, commissioners, and PPI representatives and key stakeholders and organisations (e.g. Hospice UK) and on social media. Key outputs will be recommendations for a specialist palliative care discharge proforma.Trial registrationRegistered in ISRCTN Registry on 29.12.2023 ref: ISRCTN18098027.

The Impact of Real-Time Documentation of In-Hospital Medication Changes on Preventing Undocumented Discrepancies at Discharge and Improving Physician-Pharmacist Communication: A Retrospective Cohort Study and Survey.

Transitional medication safety is crucial, as miscommunication about medication changes can lead to significant risks. Unclear or incomplete documentation during care transitions can result in outdated or incorrect medication lists at discharge, potentially causing medication errors, adverse drug events, and inadequate patient education. These issues are exacerbated by extended hospital stays and multiple care events, making accurate medication recall challenging at discharge. Thus, we aimed to investigate how real-time documentation of in-hospital medication changes prevents undocumented medication changes at discharge and improves physician-pharmacist communication. We conducted a retrospective cohort study in a tertiary hospital. Two pharmacists reviewed medical records of patients admitted to the acute medical unit from April to June 2020. In-hospital medication discrepancies were determined by comparing preadmission and hospitalization medication lists and it was verified whether the physician's intent of medication changes was clarified by documentation. By a documentation rate of medication changes of 100% and <100%, respectively, fully documented (FD) and partially documented (PD) groups were defined. Any undocumented medication changes at discharge were considered a "documentation error at discharge". Pharmacists' survey was conducted to assess the impact of appropriate documentation on the pharmacists. After reviewing 400 medication records, patients were categorized into FD (61.3%) and PD (38.8%) groups. Documentation errors at discharge were significantly higher in the PD than in the FD group. Factors associated with documentation errors at discharge included belonging to the PD group, discharge from a non-hospitalist-managed ward, and having three or more intentional discrepancies. Pharmacists showed favorable attitudes towards physician's documentation. Appropriate documentation of in-hospital medication changes, facilitated by free-text communication, significantly decreased documentation errors at discharge. This analysis underlines the importance of communication between pharmacists and hospitalists in improving patient safety during transitions of care.

Impact of transitions of care nurse navigation on post-discharge follow-up.

11126 Background: Poor discharge communication is among the primary causes of readmissions and many patients are lost to follow-up (F/U) post-discharge (PD). For newly diagnosed (DX) cancer patients, the coordination of care from inpatient (IP) to outpatient (OP) follow-up is critical. At the Sidney Kimmel Cancer Center in Philadelphia, we saw a no show (NS) rate of 6.6% for PD F/U appointments (Oct-Dec 2022) resulting from deficient communication. To improve the IP to OP transition for cancer patients, a Transition of Care Nurse Navigator (ToC NN) pilot was initiated to support patients discharged from Thomas Jefferson University Hospital (TJUH). The goal was to complete 80% of PD visits and reduce the NS rate by 20% by 12/31/23. Methods: The target population are patients that are newly DX solid tumor patients that will be discharged to home/rehab and need an OP Medical Oncology appointment. Through communication with hospitalists, IP Fellows/Residents, and/or Attendings, the ToC NN is referred eligible patients. The ToC NN visits patients during hospitalization or follows-up post-discharge to assess Health Related Social Needs and distress. PD F/U appointments are communicated during the initial contact along with information about the OP resources available and referrals are made based on patient interest/needs to social work, nutrition, or supportive medicine. All communication is documented by the EMR and the oncology care team is notified. The ToC NN follows up with the patient/patient’s family member 48-72 hours after hospital discharge to check in and do a symptom management call. Additional F/U calls are made as needed. The ToC NN serves as the patient’s point of contact (POC) from discharge to OP new patient visit (NPV) appointment. Results: The pilot exceeded the 80% goal of completion of PD visits. It revealed a 41.4% increase of PD NPV completion and a 21.9% decrease of NS rate from the 2022 to 2023 data. Conclusions: The ToC NN services showed significant impact in supporting patients transition from IP to OP. Our findings confirm having a contact after hospital discharge increases the completion of PD visits due to effective communication and support. [Table: see text]

Discharge Interventions for Limited English Proficiency Patients: A Scoping Review.

Limited English proficiency patients are required under federal law to receive language-concordant care, yet they still receive substandard discharge instructions compared to English-speaking patients. We aimed to summarize the interventions carried out to improve discharge instructions in the limited English proficiency population. We conducted a scoping review of academic and gray literature from the United States using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols for Scoping Reviews guidelines. We searched PubMed, Embase, and CINAHL for studies to improve discharge communication. Of the 3330 studies, 19 studies met the criteria. Core types of interventions included written interventions alone, educational interventions alone, written and educational interventions, audio and visual interventions, and other types of interventions. Even among the same core types of interventions, there were differences in types of interventions, outcomes examined, and results. The majority of included interventions that studied satisfaction as an outcome measure showed improvement, while the other outcomes were not improved or worsened. More rigorous methodology and community involvement are necessary to further analyze discharge interventions for patients with limited English proficiency (LEP).

Rounds Redesign: Our Experience In Splitting Interdisciplinary Rounds

Our hospital developed and implemented a major redesign of interdisciplinary rounds in order to achieve more efficient interdisciplinary communication in this challenging post-COVID era. The goal was to involve all key participants in a structured initiative to improve discharge planning, review important patient safety indicators, and enhance patient-physician communication. The comprehensive redesign, based on the Institute for Healthcare Improvement model, restructured the rounds into two distinct components: interdisciplinary disposition and clinical rounds. This new, dichotomous structure resulted in improved median discharge time, better identified estimated date of discharge and streamlined communication among care team providers. Combined with second rounds by physicians on patients getting discharged, there was an improvement in patient experience domains.

Improving written discharge communication in an acute stroke unit

Improving written discharge communication in an acute stroke unit

Thrown in at the deep end: a qualitative study with physicians on the purpose and challenges of discharge interviews

ABSTRACT Objectives Against the backdrop of poor discharge communication in hospitals, this study explores the purpose of discharge interviews from the physicians’ perspective and the challenges they are confronted with. Discharge interviews are legally required in Germany as part of the discharge management. Led by the ward physician, the discharge interview should summarize relevant information about the hospital stay, medication, lifestyle interventions and follow-up treatment. Methods Semi-structured interviews with n = 12 physicians were conducted at Heidelberg University Hospital between February and April 2020. Qualitative content analysis was carried out using MAXQDA. Results Physicians reported gaining information, providing information, and answering open-ended questions as the purpose of the discharge interview. Challenges in conducting discharge interviews were related to finding a common language, patient-related challenges, conditions of everyday ward life, and lack of training. Physicians reported receiving no explicit training on discharge interviews. While professional experience seems to mitigate the lack of training, some physicians expressed a prevailing sense of insecurity. Conclusion The lack of preparation for discharge interviews in medical school makes it particularly challenging for physicians to translate their theoretical knowledge into patient-centered discharge communication. Medical training on discharge interviews should be expanded in terms of theoretical input on the ideal content, its purpose and potential (e.g. in reducing readmissions), as well as practical exercises.

Assessing Discharge Communication and Follow-up of Acute Kidney Injury in British Columbia: A Retrospective Chart Review.

Acute kidney injury (AKI) affects up to 20% of hospitalizations and is associated with chronic kidney disease, cardiovascular disease, increased mortality, and increased health care costs. Proper documentation of AKI in discharge summaries is critical for optimal monitoring and treatment of these patients once discharged. Currently, there is limited literature evaluating the quality of discharge communication after AKI. This study aimed to evaluate the accuracy and quality of documentation of episodes of AKI at a tertiary care center in British Columbia, Canada. This was a retrospective chart review study of adult patients who experienced AKI during hospital admission between January 1, 2018, and December 31, 2018. Laboratory data were used to identify all admissions to the cardiac and general medicine ward complicated by AKI defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. A random sample of 300 AKI admissions stratified by AKI severity (eg, stages 1, 2, and 3) were identified for chart review. Patients were excluded if they required ongoing renal replacement therapy after admission, had a history of kidney transplant, died during their admission, or did not have a discharge summary available. Discharge summaries were reviewed for documentation of the following: presence of AKI, severity of AKI, AKI status at discharge, practitioner and laboratory follow-up plans, and medication changes. A total of 1076 patients with 1237 AKI admissions were identified. Of the 300 patients selected for discharge summary review, 38 met exclusion criteria. In addition, AKI was documented in 140 (53%) discharge summaries and was more likely to be documented in more severe AKI: stage 1, 38%; stage 2, 51%; and stage 3, 75%. Of those with their AKI documented, 94 (67%) documented AKI severity, and 116 (83%) mentioned the AKI status or trajectory at the time of discharge. A total of 239 (91%) of discharge summaries mentioned a follow-up plan with a practitioner, but only 23 (10%) had documented follow-up with nephrology. Patients with their AKI documented were more likely to have nephrology follow-up than those without AKI documented (17% vs 1%). Regarding laboratory investigations, 92 (35%) of the summaries had documented recommendations. In summaries that included medications typically held during AKI, only about half made specific reference to those medications being held, adjusted, or documented a post-discharge plan for that medication. For those with nonsteroidal anti-inflammatory drugs (NSAIDs) listing, 64% of discharge summaries mentioned holding, and 9% mentioned a discharge plan. For those with angiotensin converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) listing, 38% mentioned holding these medications, and 46% mentioned a discharge plan. In summaries with diuretics listed, 35% mentioned holding, and 51% included a discharge plan. We found suboptimal quality and completeness of discharge reporting in patients hospitalized with AKI. This may contribute to inadequate follow-up and post-hospitalization care for this patient population. Strategies are required for increasing the presence and quality of AKI reporting in discharge summaries. Limitations include our definition of AKI based on lab criteria, which may have missed some of the injuries that met the criteria based on urine output. Another limitation is that our definition of AKI based on the highest and lowest creatinine during admission may have led to some overclassification. In addition, without outpatient laboratories, it is possible that we have not captured the true baseline creatinine in some patients.

CLINICIAN AND STAFF PERSPECTIVES IN TRANSITIONS OF CARE FOR DUAL-USE VETERANS LIVING WITH DEMENTIA

Abstract The Veterans Administration (VA) has partnered with non-VA hospitals to improve access to care. However, older Veterans living with dementia (VLWD) who use both VA and non-VA care may experience gaps in care, placing them at risk of adverse health outcomes during transitions. This research aims to understand the barriers and facilitators in transitions of care for VLWD following non-VA hospitalization. We conducted 23 interviews with VA and non-VA clinicians involved in transitions of care for VLWD. Snowball sampling was used to identify participants, and rapid analysis identified themes. VA Participants faced significant challenges in receiving timely discharge communication from non-VA stakeholders, relying on VLWD, who are poor historians, for information about their non-VA hospitalization. Inadequate staffing for care coordination was also a barrier to timely care, resulting in frustration for VLWD and their families when tests had to be redone due to a lack of appropriate documentation from non-VA hospitals. Both VA and non-VA stakeholders experienced similar care coordination challenges for VLWD, their families, and clinicians. Non-VA stakeholders described the VA as a “black box” due to a lack of communication and collaboration. However, stakeholders expressed a desire to provide quality care, improve care coordination, and give timely care to veterans. These findings highlight the barriers experienced by VA and non-VA stakeholders and provide opportunities for improvement in coordinating care for VLWD. Implementing care coordination programs and improving communication and collaboration between VA and non-VA stakeholders can improve the quality of care for VLWD and their families during transitions.

Impact of COVID-19 visitation policies and hospital capacity on discharge readiness in medicine patients

BackgroundCOVID-19 impacted the experience of being hospitalized with the widespread adoption of strict visitation policies to ensure healthcare worker safety. One result was decreased time of caregivers at the bedside of hospitalized patients.ObjectiveTo understand the impact of pandemic-related system effects on patient-reported discharge preparation.DesignThis mixed methods study included interviews with a sample of discharged patients during April 2020, and quantitative hospital data from April 2020 to February 2021.Participants616 patients completed a measure of discharge readiness on their day of discharge and 38 patients completed interviews about their discharge experiences.Main measuresReadiness for discharge (RHDS), visitation policies, ward structure changes, COVID-19-unit census, time into the COVID-19 pandemic, patient characteristics (age, sex, race/ethnicity), admission type (planned/unplanned, for COVID-19), and discharge destination (home, home health, skilled nursing).Key resultsAdult patients aged 30–45 (vs. young and older adult patients) and those being discharged to places other than home (e.g., skilled nursing facility) or to out-of-state residences report lower readiness (p < 0.05) on RHDS. Patient interviews revealed some gaps in discharge communication but, overall, patients expressed high discharge readiness and few concerns about how COVID-19 system changes impacted their discharge preparation.ConclusionsWhile there is some evidence that visitation policies and unit census may impact patient perceptions of discharge preparation, personal characteristics contributed more significantly to discharge readiness than system changes during COVID-19. Participant interviews demonstrated agreement, as most participants were discharged home and identified strong personal feelings of readiness for discharge.Clinical trials registration: ClinicalTrials.gov ID NCT04248738, https://clinicaltrials.gov/ct2/show/NCT04248738.

Assessing Discharge Communication and Follow-Up of AKI: An Opportunity for Quality Improvement

Assessing Discharge Communication and Follow-Up of AKI: An Opportunity for Quality Improvement

The transition tightrope: Optimizing post-discharge care for acute leukemia patients.

323 Background: Patients with acute leukemia who are discharged after a hospitalization are at high risk of complications and increased risk of readmissions. We reviewed discharge plans at an academic cancer center and found a gap of inconsistently scheduled follow-up appointments after discharge, and we sought to improve the transition of care for this population. Methods: Utilizing A3 methodology, we focused on ensuring acute leukemia patients had a follow-up visit in the clinic or infusion treatment area within 5 days of discharge, which was the timeline supported by literature review. Our improvement team performed a Gemba walk in November 2021 to observe discharge planning and outpatient follow-up appointment scheduling processes, and we mapped root causes of poor care transitions on a fishbone diagram. Many of the coordinated steps required for a seamless discharge and acceptance into outpatient care were not consistently performed. We utilized a pareto chart to stratify root causes and narrowed in on 3 key drivers: 1) standard process for discharge communication between in- &amp; out-patient teams; 2) access to schedulers to secure appointments; and 3) escalation pathways when no appointment slots were available. We introduced 3 interventions: a direct phone line for the inpatient team to contact the infusion area schedulers for post-discharge appointments, an escalation pathway when schedules appeared fully booked, and a discharge navigator flowsheet in our electronic medical record (EMR) to anticipate discharge needs and facilitate standardized, efficient communication. Results: As a result of our interventions, the percentage of patients with an outpatient follow-up visit within 5 days increased from 61% to 94% between January and May 2022. Streamlining communication pathways (e.g., an automated EMR message to schedulers and a direct phone line for urgent escalation) led to initial improvements in timely follow-up visits. The EMR discharge navigator facilitated upstream identification of post-discharge needs and directed communication to the appropriate infusion area and clinic pools to schedule appointments. The discharge navigator continues to be used in the hematology service; one year after its launch, the EMR tool is utilized in 38% of all hematology discharges. Conclusions: Timely outpatient follow-up to address acute symptoms is a key method to decrease readmission risk, but inconsistent scheduling practices presented barriers at our cancer center. Instituting standardized scheduling protocols in the EMR and escalation pathways enabled nearly all our patients with acute leukemia to secure outpatient visits within 5 days of discharge. We are building on these initial efforts to disseminate and sustain utilization of the tool for all hematology and oncology patients in our center.

Implementing Electronic Discharge Communication Tools in Pediatric Emergency Departments: Multicountry, Cross-Sectional Readiness Survey of Nurses and Physicians.

Pediatric emergency departments (ED) in many countries are implementing electronic tools such as kiosks, mobile apps, and electronic patient portals, to improve the effectiveness of discharge communication. This study aimed to survey nurse and physician readiness to adopt these tools. An electronic, cross-sectional survey was distributed to a convenience sample of currently practicing ED nurses and physicians affiliated with national pediatric research organizations in Canada, Australia, and New Zealand. Survey development was informed by the nonadoption, abandonment, scale-up, spread, sustainability framework. Measures of central tendency, and parametric and nonparametric tests were used to describe and compare nurse and physician responses. Out of the 270 participants, the majority were physicians (61%, 164/270), female (65%, 176/270), and had 5 or more years of ED experience (76%, 205/270). There were high levels of consensus related to the value proposition of electronic discharge communication tools (EDCTs) with 82% (221/270) of them agreeing that they help parents and patients with comprehension and recall. Lower levels of consensus were observed for organizational factors with only 37% (100/270) agreeing that their staff is equipped to handle challenges with communication technologies. Nurses and physicians showed significant differences on 3 out of 21 readiness factors. Compared to physicians, nurses were significantly more likely to report that EDs have a responsibility to integrate EDCTs as part of a modern system (P<.001) and that policies are in place to guide safe and secure electronic communication (P=.02). Physicians were more likely to agree that using an EDCT would change their routine tasks (P=.04). One third (33%, 89/270) of participants indicated that they use or have used EDCT. Despite low levels of uptake, both nurses and physicians in multiple countries view EDCTs as a valuable support to families visiting pediatric ED. Leadership for technology change, unclear impact on workflow, and disparities in digital literacy skills require focused research effort.