Discharge Communication Research Articles

Practice of It-Based Discharge Communication in General Surgery Wards at The Kenyatta National Hospital

Purpose: The current study sought to investigate the practice of IT-based discharge communication in general surgery wards at the Kenyatta National Hospital.
 Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely General surgery ward, Urology ward and Neurology ward. A semi structured questionnaire was used to collect both qualitative and quantitative data with the use of SPSS version 25.
 Results: The findings revealed that there is a significant difference between the mean responses of the patients in General surgery ward and Neurology ward (-.299*, P= 0.001). Likewise, there is a significant difference between the mean responses of the patients in Urology ward and General surgery ward (-.417*, P= 0.000). The correlation findings indicated that there is a positive and significant association between IT-based discharge communication practices and patient health outcomes at KNH (r=0.533**, p=0.000). This was supported by the regression findings that indicated that IT-based discharge communication practices have a positive and significant effect on patient health outcomes at KNH (β = 0.305, p=0.000). This implies that improvement in 1 unit of IT-based discharge communication practices leads to an improvement in patient health outcomes at KNH by 0.305 units (vice versa is also true).
 Unique contributions to theory, policy and practice: Since, well-designed and implemented IT systems increase communication, coordination, and knowledge retention, resulting in better results for discharged patients, their families, caregivers, and primary healthcare professionals, Kenyan hospitals are encouraged to pursue the IT direction and put into practice the best IT-based communication infrastructure for current and future quality service delivery

Communication of palliative care needs in discharge letters from hospice providers to primary care: a multisite sequential explanatory mixed methods study

BackgroundThe provision of palliative care is increasing, with many people dying in community-based settings. It is essential that communication is effective if and when patients transition from hospice to community palliative care. Past research has indicated that communication issues are prevalent during hospital discharges, but little is known about hospice discharges.MethodsAn explanatory sequential mixed methods study consisting of a retrospective review of hospice discharge letters, followed by hospice focus groups, to explore patterns in communication of palliative care needs of discharged patients and describe why these patients were being discharged. Discharge letters were extracted for key content information using a standardised form. Letters were then examined for language patterns using a linguistic methodology termed corpus linguistics. Thematic analysis was used to analyse the focus group transcripts. Findings were triangulated to develop an explanatory understanding of discharge communication from hospice care.ResultsWe sampled 250 discharge letters from five UK hospices whereby patients had been discharged to primary care. Twenty-five staff took part in focus groups. The main reasons for discharge extracted from the letters were symptoms “managed/resolved” (75.2%), and/or the “patient wishes to die/for care at home” (37.2%). Most patients had some form of physical needs documented on the letters (98.4%) but spiritual needs were rarely documented (2.4%). Psychological/emotional needs and social needs were documented in 46.4 and 35.6% of letters respectively. There was sometimes ambiguity in “who” will be following up “what” in the discharge letters, and whether described patients’ needs were resolved or ongoing for managing in the community setting. The extent to which patients received a copy of their discharge letter varied. Focus groups conveyed a lack of consensus on what constitutes “complexity” and “complex pain”.ConclusionsThe content and structure of discharge letters varied between hospices, although generally focused on physical needs. Our study provides insights into patterns associated with those discharged from hospice, and how policy and guidance in this area may be improved, such as greater consistency of sharing letters with patients. A patient-centred set of hospice-specific discharge letter principles could help improve future practice.

The Practice of Written Discharge Communication Practices in General Surgery Wards at The Kenyatta National Hospital

Purpose: The current study sought to investigate the practice of written discharge communication practices in general surgery wards at the Kenyatta National Hospital
 Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely the General surgery ward, Urology ward and Neurology ward. A -semi-structured questionnaire was used to collect both qualitative and quantitative data. A statistical Package for Social Sciences (SPSS version 25) was used in the data analysis.
 Results: The findings revealed that there is a positive and significant association between written discharge communication practices and patient health outcomes at KNH (r=0.587**, p=0.000). It was further noted that 77 of the respondents in the Neurology unit (mean = 2.07) and 52 of them in the general unit (mean = 2.65) agreed with the statements regarding the written discharge communication practices affecting patient health outcomes. However, 51 of them in the general unit (mean = 3.19) were of neutral opinion. There was also a significant difference between the mean responses of the patients in the Neurology ward and General surgery ward (.312*, P=0.011). Likewise, there was a significant difference between the mean responses of the patients in the Urology ward and General surgery ward (-.538*, P=0.000). This was supported by the regression findings that indicated that written discharge communication practices have a positive and significant effect on patient health outcomes at KNH (β= 0.373, p=0.000). This implies that improvement in 1 unit of written discharge communication practices leads to an improvement in patient health outcomes at KNH by 0.373 units.
 Unique contributions to theory, policy and practice: Based on the study findings, the current study, therefore, recommends an urgent demand for the widespread application of standardized procedures, paperwork, and training to enhance crucial discharge information exchanged between healthcare providers and between Health care providers and discharged patients

Development and pilot implementation of a patient-oriented discharge summary for critically Ill patients.

BACKGROUNDPatients leaving the intensive care unit (ICU) often experience gaps in care due to deficiencies in discharge communication, leaving them vulnerable to increased stress, adverse events, readmission to ICU, and death. To facilitate discharge communication, written summaries have been implemented to provide patients and their families with information on medications, activity and diet restrictions, follow-up appointments, symptoms to expect, and who to call if there are questions. While written discharge summaries for patients and their families are utilized frequently in surgical, rehabilitation, and pediatric settings, few have been utilized in ICU settings. AIMTo develop an ICU specific patient-oriented discharge summary tool (PODS-ICU), and pilot test the tool to determine acceptability and feasibility.METHODSPatient-partners (i.e., individuals with lived experience as an ICU patient or family member of an ICU patient), ICU clinicians (i.e., physicians, nurses), and researchers met to discuss ICU patients’ specific informational needs and design the PODS-ICU through several cycles of discussion and iterative revisions. Research team nurses piloted the PODS-ICU with patient and family participants in two ICUs in Calgary, Canada. Follow-up surveys on the PODS-ICU and its impact on discharge were administered to patients, family participants, and ICU nurses.RESULTSMost participants felt that their discharge from the ICU was good or better (n = 13; 87.0%), and some (n = 9; 60.0%) participants reported a good understanding of why the patient was in ICU. Most participants (n = 12; 80.0%) reported that they understood ICU events and impacts on the patient’s health. While many patients and family participants indicated the PODS-ICU was informative and useful, ICU nurses reported that the PODS-ICU was “not reasonable” in their daily clinical workflow due to “time constraint”.CONCLUSIONThe PODS-ICU tool provides patients and their families with essential information as they discharge from the ICU. This tool has the potential to engage and empower patients and their families in ensuring continuity of care beyond ICU discharge. However, the PODS-ICU requires pairing with earlier discharge practices and integration with electronic clinical information systems to fit better into the clinical workflow for ICU nurses. Further refinement and testing of the PODS-ICU tool in diverse critical care settings is needed to better assess its feasibility and its effects on patient health outcomes.

Automated telephone follow-up programs after hospital discharge: Do older adults engage with these programs?

Health systems have developed automated telephone call programs to screen and triage patients' post-hospital discharge issues and concerns. The aims of our study were to determine whether and how older adults engage with automated post-hospital discharge telephone programs and to describe the prevalence of patient-reported post-discharge issues. We identified all telephone calls made by an urban academic medical center as part of a post-hospital discharge program between May 1, 2018 and April 30, 2019. The program used automated telephone outreach to patients or their caregivers that included 11 distinct steps 3 days post-discharge. All adults discharged home from the hospital, were included, and we categorized patients into ≤64 years, 65-84 years, and ≥85 years age groups. We then compared call reach rate, completeness of 11-step calls and patient-reported issues between age groups. Eighteen thousand and seventy six patients were included. More patients 65-84 years old were reached compared to patients ≤64 years old (84.3% vs. 78.9%, AME 5.52%; 95%CI: 3.58%-7.45%). Completion rates of automated calls for those ≥85 years oldwere also high. Patients ≥85 years old were more likely to have questions about their follow-up plans and need assistance scheduling appointments compared to those ≤64 years old (19.0% vs. 11.9%, AME 7.0% (95%CI: 2.7%-11.3%). Post-hospital automated telephone calls are feasible and effective at reaching older adults. Future work should focus on improving discharge communication to ensure older adults are aware of their follow-up plan and appointments.

Electronic Discharge Communication Tools Used in Pediatric Emergency Departments: Systematic Review.

BackgroundElectronic discharge communication tools (EDCTs) are increasingly common in pediatric emergency departments (EDs). These tools have been shown to improve patient-centered communication, support postdischarge care at home, and reduce unnecessary return visits to the ED.ObjectiveThis study aimed to map and assess the evidence base for EDCTs used in pediatric EDs according to their functionalities, intended purpose, implementation context features, and outcomes.MethodsA systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures for identification, screening, and eligibility. A total of 7 databases (EBSCO, MEDLINE, CINAHL, PsycINFO, EMBASE Scopus, and Web of Science) were searched for studies published between 1989 and 2021. Studies evaluating discharge communication–related outcomes using electronic tools (eg, text messages, videos, and kiosks) in pediatric EDs were included. In all, 2 researchers independently assessed the eligibility. Extracted data related to study identification, methodology, settings and demographics, intervention features, outcome implementation features, and practice, policy, and research implications. The Mixed Method Appraisal Tool was used to assess methodological quality. The synthesis of results involved structured tabulation, vote counting, recoding into common metrics, inductive thematic analysis, descriptive statistics, and heat mapping.ResultsIn total, 231 full-text articles and abstracts were screened for review inclusion with 49 reports (representing 55 unique tools) included. In all, 70% (26/37) of the studies met at least three of five Mixed Method Appraisal Tool criteria. The most common EDCTs were videos, text messages, kiosks, and phone calls. The time required to use the tools ranged from 120 seconds to 80 minutes. The EDCTs were evaluated for numerous presenting conditions (eg, asthma, fracture, head injury, fever, and otitis media) that required a range of at-home care needs after the ED visit. The most frequently measured outcomes were knowledge acquisition, caregiver and patient beliefs and attitudes, and health service use. Unvalidated self-report measures were typically used for measurement. Health care provider satisfaction or system-level impacts were infrequently measured in studies. The directionality of primary outcomes pointed to positive effects for the primary measure (44/55, 80%) or no significant difference (10/55, 18%). Only one study reported negative findings, with an increase in return visits to the ED after receiving the intervention compared with the control group.ConclusionsThis review is the first to map the broad literature of EDCTs used in pediatric EDs. The findings suggest a promising evidence base, demonstrating that EDCTs have been successfully integrated across clinical contexts and deployed via diverse technological modalities. Although caregiver and patient satisfaction with EDCTs is high, future research should use robust trials using consistent measures of communication quality, clinician experience, cost-effectiveness, and health service use to accumulate evidence regarding these outcomes.Trial RegistrationPROSPERO CRD42020157500; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157500

A Call for Implementation of an Evidence-Based, Quality Improvement, Decompensated Cirrhosis Discharge Care Bundle in Australia

A growing body of research suggests that evidence-based interventions can tackle high rates of hospital readmissions among patients with decompensated cirrhosis. Care bundles are a prime example of an evidence-based intervention to reduce hospital readmissions through documentation and communication. In this pilot study, a comprehensive baseline audit of electronic medical records of 497 discharges for 175 patients was conducted to assess the current standards of care on discharge from Blacktown Hospital, Australia, and the scope for introducing a care bundle. Our results demonstrated suboptimal discharge communication in a number of areas: Only 54% of decompensated cirrhosis patients had a follow-up appointment pre-scheduled at discharge. Despite alcohol being identified as a key cause of cirrhosis in 60% of patients, a review by alcohol services was conducted on only 24.9% of patients. Moreover, a general lack of focus on patient education and health literacy was identified. In conclusion, our pilot study has highlighted areas for improvement in the standard of care provided to this cohort of patients. Implementation of a standardized care bundle could address the current shortfalls, improve the standard of care and refocus discharge planning to address health literacy and education in patients admitted with a decompensated liver.

Practice of Person-Based Discharge Communication Practices in General Surgery Wards at The Kenyatta National Hospital

Purpose: The current study sought to investigate the practice of person-based discharge communication practices in general surgery wards at the Kenyatta National Hospital.
 Methodology: The study used the descriptive research design approach. A stratified sampling technique was used to recruit 180 patients who had been discharged in the last one month prior to the study from surgical wards namely the General surgery ward, Urology ward and Neurology ward. A semi-structured questionnaire was used to collect both qualitative and quantitative data. A statistical Package for Social Sciences (SPSS version 25) was used in the data analysis.
 Results: The findings show that 77 of the respondents in the Neurology unit (mean = 2.97), 51 of them in the general surgical unit (mean = 1.80) and 52 of them in the urology unit (mean = 2.11) agreed that person-based discharge communication practices affect patient health outcomes. There was also a significant difference between the mean responses of the patients in the Neurology ward and Urology ward (-.267*, P=0.026). Likewise, there was a significant difference between the mean responses of the patients in the Urology ward and General surgery ward (-0.313*, P=0.017). Furthermore, the findings indicated that there is a statistically significant relationship between person-based discharge communication practices at KNH given the Neurology ward, Urology ward and General surgery ward departments {(F (2, 177) =3.517, p=0.032< 0.05}. This was supported by the regression findings that indicated that person-based discharge communication practices have a positive and significant effect on patient health outcomes at KNH (β= 0.305, p=0.000). This implies that improvement in one unit of person-based discharge communication practices leads to an improvement in patient health outcomes at KNH by 0.305 units (vice versa is also true).
 Unique contributions to theory, policy and practice: Based on the study findings, the current study, therefore, recommends the health care practitioners to continuously appreciate the importance placed on constant and regular use of this discharge communication for better patient health outcomes and staff satisfaction, as well as contribute to cost savings to the organization.

Reducing oncology readmissions through a multidisciplinary discharge approach.

6561 Background: Hospital readmissions are associated with increased health care utilization and unfavorable patient outcomes. Oncology patients have an increased risk of hospital readmission compared to the general patient population. The 30-day readmission rate for cancer patients at our institution is 27.7% which is higher than the reported national average of 20.2%. We sought to reduce 30-day hospital readmission rates by 25% for solid tumor oncology patients through a prospective integrated multidisciplinary discharge approach. Methods: Hospital readmissions for adult patients with a known solid tumor cancer diagnosis admitted to the oncology service at UVA from Jan 2019 – Apr 2019 were identified. Baseline information on tumor type, reason for readmission, interventions, length of stay (LOS), and inpatient morbidity and mortality (including ICU admission and transition to hospice) were collected via retrospective review. Qualitative and quantitative tools including process maps, cause-and-effect diagrams, Pareto charts, and priority matrix were used to identify potential areas for intervention. Two PDSA cycles were implemented: daily multidisciplinary discharge rounds with physicians, nursing, social work, case management, and PT/OT (PDSA1), and a templated discharge email to patients’ primary oncology team including attending oncologist, mid-level providers, nurse coordinator, pharmacist, and urgent care team (PDSA2). An SPC chart with 3-σ limits and t-test of unequal variance with 2-sided p-value was used to evaluate impact on readmission rates from baseline to PDSA2. Results: Following PDSA1 (May 2019 – Oct 2019), the 30-day readmission was 25.7%; PDSA2 was postponed due to COVID-19, however the 30-day readmission rate remained stable during the pandemic. Following PDSA2 (Sept 2021 – Dec 2021), the 30-day readmission rate was 18.2% corresponding to an absolute decrease of 34.3% which was statistically significant (p≤0.05). This was associated with a trend towards increased LOS, rate of ICU admission, and case-mix severity index although not statistically significant. There was no significant difference in inpatient mortality or transition to hospice (Table). Conclusions: Implementation of multidisciplinary discharge rounds and templated discharge communication resulted in a significant decrease in rate of 30-day readmissions for solid tumor oncology patients. There was a trend towards increased LOS and ICU admissions without increased inpatient mortality. Improvement in discharge email compliance and implementation of an urgent symptom clinic may further reduce the 30-day readmission rate. [Table: see text]

Written discharge communication of diagnostic and decision-making information for persons living with dementia during hospital to skilled nursing facility transitions

Hospital-to-skilled nursing facility (SNF) transitions constitute a vulnerable point in care for people with dementia and often precede important care decisions. These decisions necessitate accurate diagnostic/decision-making information, including dementia diagnosis, power of attorney for health care (POAHC), and code status; however, inter-setting communication during hospital-to-SNF transitions is suboptimal. This retrospective cohort study examined omissions of diagnostic/decision-making information in written discharge communication during hospital-to-SNF transitions. Omission rates were 22% for dementia diagnosis, 82% and 88% for POAHC and POAHC activation respectively, and 70% for code status. Findings highlight the need to clarify and intervene upon causes of hospital-to-SNF communication gaps.

In Pursuit of Better Care Transitions: Lessons Learned from a Co-Designed Project.

In this commentary, we reflect on our experience of co-designing an intervention to address challenges due to delayed hospital discharge (known as alternate level of care in Canada). Through a series of focus groups and co-design sessions, we identified common challenges with delayed discharge (including a lack of services while waiting for discharge and poor communication with the care team). In co-designing service improvements, we (1) amplified the voices of patients and caregivers, which helped them feel unified in their experience and (2) developed tools that aim to improve patient, caregiver and provider experiences. In this commentary, we reflect on these impacts along with the key lessons learned.

Barriers and facilitators to family caregiver training during home health care: A multisite qualitative analysis.

BackgroundDuring Medicare home health care (HHC), family caregiver assistance is often integral to implementing the care plan and avoiding readmission. Family caregiver training delivered by HHC clinicians (nurses and physical therapists [PTs]) helps ensure caregivers' ability to safely assist when HHC staff are not present. Yet, family caregiver training needs often go unmet during HHC, increasing the risk of adverse patient outcomes. There is a critical knowledge gap regarding challenges HHC clinicians face in providing necessary family caregiver training.MethodsMultisite qualitative study using semi‐structured, in‐depth key informant interviews with Registered Nurses (n = 11) and PTs (n = 8) employed by four HHC agencies. Participating agencies were diverse in rurality, scale, ownership, and geographic region. Key informant interviews were audio‐recorded, transcribed, and analyzed using directed content analysis to identify existing facilitators and barriers to family caregiver training during HHC.ResultsClinicians had an average of 9.3 years (range = 1.5–23 years) experience in HHC, an average age of 45.1 years (range = 28–63 years), and 95% were female. Clinicians identified facilitators and barriers to providing family caregiver training at the individual, interpersonal, and structural levels. The most salient factors included clinician–caregiver communication and rapport, accuracy of hospital discharge information, and access to resources such as additional visits and social work consultation. Clinicians noted the COVID‐19 pandemic introduced additional challenges to providing family caregiver training, including caregivers' reduced access to hospital staff prior to discharge.ConclusionsHHC clinicians identified a range of barriers and facilitators to delivering family caregiver training during HHC; particularly highlighting the role of clinician–caregiver communication. To support caregiver training in this setting, there is a need for updated reimbursement structures supporting greater visit flexibility, improved discharge communication between hospital and HHC, and structured communication aids to facilitate caregiver engagement and assessment.

Defining Minimum Necessary Communication During Care Transitions for Patients on Antihyperglycemic Medication: Consensus of the Care Transitions Task Force of the IPRO Hypoglycemia Coalition.

IntroductionAntihyperglycemic agents are significant contributors to adverse drug events, responsible for emergency department visits, hospitalizations, and death. Nationally, the rate of serious hypoglycemic events associated with these agents remains high despite widespread efforts to improve drug safety. Transitions of care between healthcare settings can lead to communication challenges between care professionals and increase the risk of adverse drug events. System-based improvements are needed to assure the safe transitions for patients with diabetes who are on antihyperglycemic agents. The objective of this study was to develop a consensus list of requisite elements that should be communicated between care settings during transitions of patients who are prescribed antihyperglycemic agents.MethodsThe Island Peer Review Organization (IPRO) Hypoglycemia Coalition identified suboptimal transitions of care as a barrier to improving patient safety and quality of diabetes care. The Coalition formed a multidisciplinary Task Force with experts in the field of diabetes care. The Task Force created a draft list of requisite communication elements through literature review and deliberation on monthly conference calls. A blinded iterative Delphi process was subsequently performed to generate a consensus list of requisite communication elements that participating experts agreed were necessary to safely and effectively assume the management of patients with diabetes upon care transitions.ResultsThe Task Force completed a series of four iterative polls from September 2015 to August 2016, resulting in a final list of 22 requisite communication elements (the Diabetes Management Discharge Communication List), with the elements conceptually categorized into three domains: diagnosis and treatment, factors affecting glycemic control or patient risk, and patient self-management.ConclusionsThe Diabetes Management Discharge Communication List provides an initial framework for the development of diabetes-specific resources to improve clinical communication between care settings.

Application of the RE-AIM Framework for the Pediatric Mild Traumatic Brain Injury Evaluation and Management Intervention: A Study Protocol for Program Evaluation.

BackgroundChildren who experience a mild Traumatic Brain Injury (mTBI) may encounter cognitive and behavioral changes that often negatively impact school performance. Communication linkages between the various healthcare systems and school systems are rarely well-coordinated, placing children with an mTBI at risk for prolonged recovery, adverse impact on learning, and mTBI re-exposure. The objective of this study is to rigorously appraise the pediatric Mild Traumatic Brain Injury Evaluation and Management (TEaM) Intervention that was designed to enhance diagnosis and management of pediatric mTBI through enhanced patient discharge instructions and communication linkages between school and primary care providers.MethodsThis is a combined randomized and 2 × 2 quasi-experimental study design with educational and technology interventions occurring at the clinician level with patient and school outcomes as key endpoints. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework will be utilized as a mix methods approach to appraise a multi-disciplinary, multi-setting intervention with the intent of improving outcomes for children who have experienced mTBI.DiscussionUtilization of the RE-AIM framework complemented with qualitative inquiry is suitable for evaluating effectiveness of the TEaM Intervention with the aim of emphasizing priorities regarding pediatric mTBI. This program evaluation has the potential to support the knowledge needed to critically appraise the impact of mTBI recovery interventions across multiple settings, enabling uptake of the best-available evidence within clinical practice.

Causes and timing of 30-day rehospitalization from skilled nursing facilities after a hospital admission for pneumonia or sepsis.

BackgroundPneumonia and sepsis are among the most common causes of hospitalization in the United States and often result in discharges to a skilled nursing facility (SNF) for rehabilitation. We described the timing and most common causes of 30-day unplanned hospital readmission following an index hospitalization for pneumonia or sepsis.Methods and findingsThis national retrospective cohort study included adults ≥65 years who were hospitalized for pneumonia or sepsis and were discharged to a SNF between July 1, 2012 and July 4, 2015. We quantified the ten most common 30-day unplanned readmission diagnoses and estimated the daily risk of first unplanned rehospitalization for four causes of readmission (circulatory, infectious, respiratory, and genitourinary). The index hospitalization was pneumonia for 92,153 SNF stays and sepsis for 452,254 SNF stays. Of these SNF stays, 20.9% and 25.9%, respectively, resulted in a 30-day unplanned readmission. Overall, septicemia was the single most common readmission diagnosis for residents with an index hospitalization for pneumonia (16.7% of 30-day readmissions) and sepsis (22.4% of 30-day readmissions). The mean time to unplanned readmission was approximately 14 days overall. Respiratory causes displayed the highest daily risk of rehospitalization following index hospitalizations for pneumonia, while circulatory and infectious causes had the highest daily risk of rehospitalization following index hospitalizations for sepsis. The day of highest risk for readmission occurred within two weeks of the index hospitalization discharge, but the readmission risk persisted across the 30-day follow-up.ConclusionAmong older adults discharged to SNFs following a hospitalization for pneumonia or sepsis, hospital readmissions for infectious, circulatory, respiratory, and genitourinary causes occurred frequently throughout the 30-day post-discharge period. Our data suggests further study is needed, perhaps on the value of closer monitoring in SNFs post-hospital discharge and improved communication between hospitals and SNFs, to reduce the risk of potentially preventable hospital readmissions.

Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians.

BackgroundAcute respiratory infection (ARI) in childhood is common, but more knowledge on the burden and natural history of ARI in the community is required. A better understanding of ARI risk factors, treatment, and outcomes will help support parents to manage their sick child at home. Digital health tools are becoming more widely adopted in clinical care and research and may assist in understanding and managing common pediatric diseases, including ARI, in hospitals and in the community. We integrated 2 digital tools—a web-based discharge communication system and the REDCap (Research Electronic Data Capture) platform—into the Pragmatic Adaptive Trial for Acute Respiratory Infection in Children to enhance parent and physician engagement around ARI discharge communication and our patient registry.ObjectiveThe objective of this study is to determine the efficacy and usability of digital tools integrated into a pediatric patient registry for ARI.MethodsSemistructured interviews and software interface usability testing were conducted with 11 parents and 8 emergency department physicians working at a tertiary pediatric hospital and research center in Perth, Western Australia, in 2019. Questions focused on experiences of discharge communication and clinical trial engagement. Responses were analyzed using the qualitative Framework Method. Participants were directly observed using digital interfaces as they attempted predetermined tasks that were then classified as success, failure, software failure, or not observed. Participants rated the interfaces using the System Usability Scale (SUS).ResultsMost parents (9/11, 82%) indicated that they usually received verbal discharge advice, with some (5/11, 45%) recalling receiving preprinted resources from their physician. Most (8/11, 73%) would also like to receive discharge advice electronically. Most of the physicians (7/8, 88%) described their usual practice as verbal discharge instructions, with some (3/8, 38%) reporting time pressures associated with providing discharge instructions. The digital technology option was preferred for engaging in research by most parents (8/11, 73%). For the discharge communication digital tool, parents gave a mean SUS score of 94/100 (SD 4.3; A grade) for the mobile interface and physicians gave a mean usability score of 93/100 (SD 4.7; A grade) for the desktop interface. For the research data management tool (REDCap), parents gave a mean usability score of 78/100 (SD 11.0; C grade) for the mobile interface.ConclusionsSemistructured interviews allowed us to better understand parent and physician experiences of discharge communication and clinical research engagement. Software interface usability testing methods and use of the SUS helped us gauge the efficacy of our digital tools with both parent and physician users. This study demonstrates the feasibility of combining qualitative research methods with software industry interface usability testing methods to help determine the efficacy of digital tools in a pediatric clinical research setting.

Primary care practitioners' perspectives of discharge communication and continuity of care for stroke survivors in Australia: A qualitative descriptive study.

Discharge communication is an important component of care transition between hospitals and community care, particularly for the complex needs of stroke survivors. Despite international research and regulation, ineffective information exchange during care transitions continues to compromise patient outcomes. Primary care practitioners are increasingly responsible for the provision of stroke care in the community, yet it is not known how their role is supported by discharge communication. The aim of this qualitative study was to describe the primary care practitioner perspective of discharge communication, identifying the barriers and enablers relative to continuity of care for stroke survivors. Semi-structured telephone interviews were conducted with primary care practitioners across Australia, between April and September 2020. Data were analysed using thematic analysis with a constant-comparison approach. The findings suggest that discharge communication is often inadequate for the complex care and recovery needs of stroke survivors. The challenges in accessing care plans were noted barriers to continuity of care, while shared understandings of stroke survivors' needs were identified as enablers. As discharge communication processes were perceived to be disconnected, primary care practitioners suggested a team approach across care settings. It is concluded that initiatives are required to increase primary care collaboration with hospital teams (which include stroke survivors and their caregivers) to improve continuity of care after stroke.

Intervention fidelity and process outcomes of the IMMENSE study, a pharmacist-led interdisciplinary intervention to improve medication safety in older hospitalized patients.

The majority of hospitalized older patients experience medication-related problems (MRPs), and there is a call for interventions to solve MRPs and improve clinical outcomes like medical visits. The IMMENSE study is a randomized controlled trial investigating the impact of a pharmacist-led interdisciplinary intervention on emergency medical visits. Its multistep intervention is based on the integrated medicines management methodology and includes a follow-up step with primary care. This study aims to describe how the intervention in the IMMENSE study was delivered and its process outcomes. The study includes the 221 intervention patients in the per-protocol group of the IMMENSE study. Both intervention delivery, reasons for not performing interventions and process outcomes were registered daily by the study pharmacists in a Microsoft Access® database. Process outcomes were medication discrepancies, MRPs and how the team solved these. A total of 121 (54.8%) patients received all intervention steps if appropriate. All patients received medication reconciliation (MedRec) and medication Review (MedRev) (step 1 and 2), while between 10% and 20% of patients were missed for medication list in discharge summary (step 3), patient counselling (step 4), or communication with general practitioner and nurse (step 5). A total of 437 discrepancies were identified in 159 (71.9%) patients during MedRec, and 1042MRPs were identified in 209 (94.6%) patients during MedRev. Of these, 292 (66.8%) and 700 (67.2%), respectively, were communicated to and solved by the interdisciplinary team during the hospital stay. The fidelity of the single steps of the intervention was high even though only about half of the patients received all intervention steps. The impact of the intervention may be influenced by not implementing all steps in all patients, but the many discrepancies and MRPs identified and solved for the patients could explain a potential effect of the IMMENSE study.

Experiences and perspectives of older patients with a return visit to the emergency department within 30\xa0days: patient journey mapping

Key summary pointsAimTo achieve patient-centered care for older patients at the emergency department (ED) it is important to include their perspective and experience, and this can be done through the patient journey method.FindingsBy mapping the patient journey, we found that waiting times and suboptimal discharge communication are almost always related to a negative experience for older patients.MessageThe novelty of this study lies within the qualitative patient journey method, which allowed us to include the voice of the patient in issues that have been previously described (i.e. waiting times and discharge communication). We believe this can guide towards patient-centered improvement initiatives that can contribute to a positive ED experience in the future, for example a time-out at the ED and a discharge check list

Pain management‐related assessment and communication across the care continuum: Consensus of the opioid task force of the island peer review organization pain management coalition

AbstractPrescription opioid analgesics contribute to serious, preventable adverse drug events (ADEs) and despite efforts ranging from regulatory changes to quality improvement initiatives, national studies indicate that opioid‐related emergency department visits and hospitalizations are increasing amid the coronavirus disease 2019 (COVID‐19) pandemic. Effective pain management is challenging during care transitions, and system imperfections make patients vulnerable to ADEs as they leave one care setting and move to another. Therefore, the Island Peer Review Organization (IPRO) pain management coalition convened a task force to develop resources to guide improvements in opioid‐related communication during patient care transitions. Create a consensus list of requisite communication elements (RCEs) that should accompany all patients prescribed opioids as they undergo care transitions. An interprofessional task force of pain management experts was convened and completed a blinded, iterative Delphi process. After four Delphi rounds, the panel reached consensus on a pain management discharge communication (PMDC) List of 24 RCEs across the domains of opioid dosing and pain management (nine elements), factors associated with adverse drug events (nine elements), and patient education and caregiver support (six elements). During transitions of care providers need detailed information on opioid dosing, pain characteristics, risk factors for adverse events, and patient/caregiver capacity to adequately manage symptoms while avoiding potentially fatal ADEs. The PMDC list may guide the development of new clinical tools, quality measures, accreditation standards, and checklists for pharmacists involved in the delivery of opioid stewardship during a care transition. Additional work is needed to design comprehensive, interprofessional opioid stewardship programs to ensure that the requisite communication elements are consistently available at the time of a care transition.