Discharge Information Research Articles

Describing Nonfatal Intimate Partner Strangulation Presentation and Evaluation in a Community-Based Hospital: Partnerships Between the Emergency Department and In-House Advocates.

To describe characteristics of strangulation, and associated medical care, documentation, and injuries of women after nonfatal intimate partner strangulation (NF-IPS) who present for care to a community-based emergency department (ED) with an associated intimate partner violence (IPV) advocacy program between 2008 and 2016. A retrospective review of 345 female ED patients' medical records who sought care at a community hospital ED following a physical assault including strangulation by an intimate partner was conducted. Demographics, characteristics related to reported signs and symptoms, injuries, and subsequent imaging, diagnoses, and discharge information were abstracted. Commonly reported symptoms were neck pain (67.2%) and headache (45.8%), with fewer patients reporting more severe symptoms such as loss of consciousness (22.6%), dysphagia (25.0%), or dysphonia (26.7%). Rates of patients disclosing strangulation to the entire multidisciplinary team and dedicated neck imaging appeared to improve between 2008 and 2014. Among the 45 patients with noted head and neck findings, 2 patients were found to have an internal carotid artery dissection, 2 patients were found to have strokes, and 1 patient was found to have an intracranial hemorrhage. Survivors of NF-IPS may present to community-based hospitals, and existing imaging guidelines can support clinicians in identifying serious internal injury such as carotid artery dissection and stroke. Further research is needed to better discern symptoms previously attributed to psychological trauma from poststrangulation brain injury. This study contributes to the growing literature on NF-IPS with data specific to community-based ED visits.

Verification of the Status of Issuance of Discharge Information Documents and Use of ‘Okusuritecho’ as Medication Handbook in Community Pharmacies

The activities of community pharmacies include collecting and sharing information about patients' hospitalization histories by checking medication registers, interviewing patients and their families, and providing information from other medical institutions. In 2020, an additional fee was established to provide pharmacies with information in a document form at the time of discharge from the hospital. This study aimed to verify the use of discharge information documents and medication handbooks as medication support for patients visiting community pharmacies after discharge from the hospital. We conducted this study on 97 patients who visited a community pharmacy after discharge from a community hospital between January 2021 and September 2021. In this survey, 17 (17/97) discharge drug information forms were obtained from patients. Surprisingly, 13 of the 17 patients were included in the Medication Book. In addition, information on hospitalization history was obtained from 82 patients and their families. Eleven patients (11/97, 11.3%) were subject to prescription inquiries. Thus, the discharge information documents were not widely used, and the information obtained from patient interviews and medication handbooks was utilized primarily for medication counselling at community pharmacies.

Design and Implementation of Ship Water Pollution Supervision and Service Information System

In order to improve the ship pollutant discharge monitoring system, control the ship pollutant discharge, establish a more convenient and efficient information communication channel for ship pollutant discharge and receiving services, a ship water pollution discharge system is designed and implemented. This system is divided into three workbenches, namely ship workbenches, enterprise workbenches and supervision workbenches. It is developed based on the front-end and back-end separation mode. The front-end uses Vue framework to implement page function, and Element UI to complete page UI design, Mapbox to display maps, and ECharts component to draw charts. The back-end is implemented through the Spring Boot framework. Redis is used for data caching to improve concurrency and provide data interfaces. Spring Security + JWT is used to achieve single sign on and permission control. The Nginx service gateway is used to achieve service load balancing. MySQL database is used to storage the water pollution discharge information. AIS historical data storage is realized through the distributed database system of Doris cluster.

Physical Characteristics Of The Krueng Seunagan Watershed And River Storage Capacity Against Peak Discharge

Peak discharge information is indispensable for flood control planning by taking into account the physiographic factors of the watershed. Flood occurs because the capacity of the watershed and river channels is smaller than the flood discharge. One of the causes of rivers' reduced flood flow capacity is vegetation cover and land use that cannot store rainfall. Thus, this paper aims to determine the peak discharge from the watershed's physical characteristics and land-use changes by comparing the river storage capacity in the Krueng Seunagan watershed. The rational method is used to calculate the peak discharge. Some of the data used in this study are the shapefile map provided by Geospatial Information Agency, land use, rainfall, soil types, and Landsat 8 OLI/TIRS digital imagery. Analysis of the physical characteristics of the watershed consists of morphology and morphometry. Land use in the area of the Krueng Seunagan watershed increased the peak discharge during the observation year (2003-2017). Besides the land-use factor, discharge is also influenced by high rainfall intensity and runoff coefficient obtained from land use analysis. In the Krueng Seunagan watershed area, the C value obtained was 0.0505 – 0.0720, indicating that the Krueng Seunagan watershed area was classified as good or harmless. The river flow density of 0.53 belongs to the medium category. The river flow increases and decreases in the flood water level, which is neither too fast nor too slow. The roundness index of the Seunagan watershed of 1.0004 indicates that the basins are widened or circular and, consequently, the rate and volume of surface runoff are fast. Krueng Seunagan watershed runoff coefficient increased by 42.51% and rainfall intensity by 37.05%, while discharge increased by 95.31%. The discharge capacity that the Krueng Seunagan River Basin can accommodate from the measurement results in the downstream watershed is 158.47 m3/sec. While the peak discharge using the rational method gets a value that varies in each year of observation from (2003-2017). The peak discharge value in 2003 amounted to 183.52 m3/sec, and the highest in 2017 amounted to 358.44 m3/sec. This shows that the river holding capacity in the Krueng Seunagan watershed will not accept the amount of peak discharge, and consequently, the flood will always occur.

P-OGC62 Home Enteral Tube Feeding: The Patient’s Perspective. Are we delivering an effective dietetic service?

Abstract Background Long term feeding tubes, managed independently at home have been shown to improve quality of life scores and in general are considered to be well tolerated. Beaumont Hospital has seen an increase in the number of patients referred for home enteral feeding (HEN) prior to neoadjuvant treatment for oesophagogastric (OG) cancer. We aimed to gain an insight into the supports, experiences and challenges encountered by these patients in an emerging service. Methods A retrospective qualitative study using data from 2019-2020. A questionnaire was adapted from a multicentre Irish study in 2017. Patients with OG cancer for treatment with curative intent, that underwent an elective feeding tube insertion for preoperative supplementary feeding were included. Patients were provided with a questionnaire via post. Data was analysed using Microsoft Excel. Results Response rate was 82% (14 of 17questionnaires). Mean age 60.4yrs (SD 11.7). 93% male (N = 13). In 36% (N = 5) tube feeding duration was < 3months and 3-6months duration in 43% (N = 6). Conclusions Overall positive feedback was received from patients regarding living with a feeding tube, confirming the important and impactful role of HEN. Priorities for service improvements: improved discharge information and resources may help reduce use of unreliable resources e.g. develop HEN discharge booklet to keep all relevant information in one accessible location, development of video education resources for consolidation of knowledge. Aim to provide more structured follow up with clear plans and channels of communication outlined for the patient. Quality improvement work with surgical team to reduce complication rate with feeding tubes.

Groundwater Withdrawals Associated with Oil and Gas Production from Water Supply Aquifers in Texas: Implications for Water Management Practices

The demand for water is continuing to increase as population and industry grow. The Natural Resources Defense Council indicated that Texas is at “extreme risk” for implementation of sustainable water management practices especially since groundwater is the supplier of much of the state’s freshwater. This study is designed to assess groundwater conservation practices in association with oil and gas production from the surrounding areas of the Carrizo-Wilcox formation in Texas. The results of this study reveal that the Railroad Commission of Texas (RRC), the governing agency for Texas oil and gas development, permits produced water to be discharged into surface waters if the discharged water quality meets Texas Surface Water Quality Standards (TSWQS) set by the Texas Commission on Environmental Quality (TCEQ) for the specific receiving water body. After careful evaluation of data provided by the Railroad Commission of Texas, it is believed that nearly 5,331,975 m3 (4,321 ac⋅ft) of produced water per year, with an average TDS of 960 mg L-1, is being removed from the Carrizo-Wilcox aquifer through discharge permits designated as “agricultural”. The RRC is not legally required to share the discharge information with local Groundwater Conservation Districts. Based on an evaluation of the reported Whole Effluent Toxicity (WET) test data, 69 discharges amount to total suspended solid (TDS) levels of less than 1,000 mg L-1, 35 are between 1,000-1,500 mg L-1, and 20 between 1,500 - 4,000 mg L-1. Although 69% of discharges exceed the secondary drinking water standard for TDS (500 mg L-1), the average of all discharges, 960 mg L-1, is in line with the arbitrary upper limit for freshwater based on the suitability for human consumption. In addition, the water quality of surface discharges complies with requirements for several water reuses associated with agricultural and industrial practices. The lack of communication between groundwater users leads to conflicting groundwater practices that have negative impacts such as contribution to aquifer over-exploitation and alteration of hydraulic gradients, in turn negatively impacting existing groundwater conservation efforts.

Community Pharmacists' Experiences and Perception about Transitions of Care from Hospital to Home in a Midwestern Metropolis.

Objectives: (1) To describe the experiences of community pharmacists in transitions of care (TOC) from hospital to home in a Midwestern metropolis; and (2) to develop instruments to measure perceived importance of TOC activities. Methods: Survey items were developed, including a six-item instrument to capture perceived importance of TOC activities. The items were piloted to examine face validity before dissemination to 310 community pharmacists. Descriptive statistics were reported. Principal component analysis and reliability analysis for the six-item instrument were performed to assess construct validity and Cronbach’s alpha, respectively. Results: The response rate was 37% (n = 118). The majority of community pharmacists estimated that they learned of a patient’s discharge on less than 10% of the occasions. There were 76 cases in which the discharged patients experienced either a prescription- or medication-related problem. For the six-item measurement of perceived importance, one component was yielded and all items loaded on the component with high values, which confirmed construct validity. The Cronbach’s alpha for these six items was 0.941, indicating high reliability. Conclusions: A large communication gap existed for community pharmacists to receive patient discharge information. The six-item instrument to measure perceived importance of TOC activities was valid and reliable.

A Multidisciplinary Approach to Improving the Pediatric Discharge Process.

A collaborative and multidisciplinary shared responsibility with providing discharge information to pediatric patients/families can support successful reassimilation to life posthospitalization. An analysis of the current discharge process at an urban pediatric hospital identified variations in discharge practices and instructions. A multidisciplinary taskforce used the Plan-Do-Study-Act methodology to standardize the discharge process including creating a discharge template, adopting a new education platform, enhancing the electronic health record, and implementing strategies to improve discharge. There was a reduction in 7-day readmission rate from preintervention 4.58 to postintervention for 4 consecutive quarters of 3.92, 4.20, 3.44, and 3.41, respectively. Percentile ranking and top box scores of the patient satisfaction measure of discharge preparation increased from 12th-62nd to 65th-95th percentile postimplementation and 81% to 88%, respectively. A local improvement initiative related to standardization of the discharge process resulted in a reduction in 7-day readmission rate and improved patient satisfaction scores.

Land-based Nitrogen Pollution Source Structure and Spatial Distribution in Guangdong-Hong Kong-Macao Greater Bay Area

Total nitrogen pollution from land-based sources carried by rivers is the main source of inorganic nitrogen entering the sea. Inorganic nitrogen pollution in the coastal waters of Guangdong-Hong Kong-Macao Greater Bay Area(GBA) is a serious problem. The water quality of an adjacent large area of the sea is classified as poor-category Ⅳ. Therefore, clarification of the scale, structure, and discharge pressure of nitrogen emissions from the land area of the GBA is needed to manage marine nitrogen pollution. Based on multi-source data, including land use, socio-economic statistics, and pollution source census information, the scale, source structure, and regional differences of total nitrogen discharge in GBA and surrounding cities were evaluated using administrative and watershed units. The results show that:①The total nitrogen emissions from the study area are approximately 332500 t. Residential waste is the main source of pollution, accounting for 55.4%, followed by cultivation, with 28.18%, while the contribution from animal husbandry and industrial production is relatively limited. ②The regional differences of total nitrogen emissions are obvious, and the total emissions from GBA(231400 t) are significantly higher than those from neighboring cities(101100 t). ③The distribution of marine pollution and intensity of land-based nitrogen pollution emissions are spatially consistent, which indicates that there is a large number of pollution emissions in the East River Basin, Northwest River Delta Basin, and Tan River Basin; the shoreline sections belonging to the basins carry the greatest emission pressure, lead to serious pollution in the Lingding Sea, Jin Bay, and Huangmao Sea.

Assessment of Healthcare Resource Utilization and Costs in Patients with Relapsed or Refractory Follicular Lymphoma Undergoing CAR-T Cell Therapy with Tisagenlecleucel: Results from the Elara Study

Assessment of Healthcare Resource Utilization and Costs in Patients with Relapsed or Refractory Follicular Lymphoma Undergoing CAR-T Cell Therapy with Tisagenlecleucel: Results from the Elara Study

EP.TH.289Diagnosis of the aetiology of acute pancreatitis at a district Hospital: A retrospective audit

Abstract Introduction The correct diagnosis of acute pancreatitis should be made in all patients within 48 hours of admission. According to recently published NICE (NG 147) guidelines for diagnosis of aetiology of acute pancreatitis should be determined in at least 80% of cases and no more than 20% should be classified as idiopathic. We aim to overview our current practice compared to guidelines. Early identification of aetiology is essential. Materials and Methods Patients diagnosed to have pancreatitis presenting to surgical assessment unit from March 1st 2019 to December 31st 2019. Sample size audited 291. The diagnosis of acute pancreatitis is made with a combination of history, physical examination and laboratory evaluation. Further investigations were done for the ethology. These patients were identified from their discharge information. They had raised amylase along with history suggestive of pancreatitis and were analysed retrospectively. Results Of all the pancreatitis patients admitted in SAU, 88 (30%) were due to biliary, 40 (16%) alcohol related, 20 (7%) other causes whereas 134 (46%) were classified as idiopathic. 3 patients self-discharged. Conclusion In our trust it seems that aetiology of acute pancreatitis is not adequately investigated. Most of other blood investigations were not performed in index admission and relevant drug history was not elicited. This failure of non-identification of gallstones could be attributed to operator dependant and they didn’t have second USS as advised. We formulated an action plan with detailed history with adequate step wise investigations which will benefit the patients.

The Mount Sinai Interdisciplinary Approach to Perioperative Care Improved the Patient Experience for Transgender Individuals.

Although medical care for transgender and gender nonbinary (TGNB) individuals is rapidly expanding, numerous gaps in the organization of quality care for TGNB individuals remain. In 2018, the Mount Sinai Center for Transgender Medicine and Surgery (CTMS) expanded its unified care approach to integrate services with an interdisciplinary inpatient team for surgical patients as part of the program. The inpatient team connected with the existing interdisciplinary ambulatory team with all pertinent medical and psychosocial information shared between the teams. The format enabled the hospital team to better prepare in advance of a patient's arrival and facilitated discharge planning as well. We sought to assess patient satisfaction with inpatient care after implementation of the interdisciplinary operation. The standard Press Ganey survey tool used by the Mount Sinai Health System to measure patient satisfaction with care was queried before and after implementation of the interdisciplinary inpatient care team. Patient ratings of inpatient care rose dramatically. Relative to other institutions nationally, Press Ganey scores rose into the 98th or 99th percentiles across all domains. The new scores represented a rise of 25% for communication with nurses, 3% for hospital environment, 25% for care transition, and 100% for willingness to recommend. The discharge information score represented a 30-fold improvement. An interdisciplinary inpatient health care team can significantly improve patient satisfaction for TGNB patients. Such an approach might be considered for other TGNB health care programs along with health care delivery in other areas of medicine.

Numerical Simulation of Flood Routing through Channels with Area Variation using Staggered Grid Method

In the event that the discharge goes to enter the channel surpasses the channel ability, than would happen floods of genuine harm to the environment around the channel. Applying the dynamic wave model, the discharge amount could be predicted in the frequent flood region if the information of discharge upstream is found out. Many numerical schemes could be utilized to discover answers to the system of differential partial equations. We proposed the usage of the staggered method to find out the solution of the system. The numerical scheme shall be used to predict the top discharge in a frequent flood region and create a flooded pocket to diminish the top discharge in the region. Based on the outcome of the numerical simulation, we may claim that a stable scheme has been created to acquire the approach resolve of the equation partial system. The staggered scheme is capable of investigating the impact of the presence of the flood pocket especially lessening the top discharge.

Does information structuring improve recall of discharge information? A cluster randomized clinical trial

The impact of the quality of discharge communication between physicians and their patients is critical on patients' health outcomes. Nevertheless, low recall of information given to patients at discharge from emergency departments (EDs) is a well-documented problem. Therefore, we investigated the outcomes and related benefits of two different communication strategies: Physicians were instructed to either use empathy (E) or information structuring (S) skills hypothesizing superior recall by patients in the S group. For the direct comparison of two communication strategies at discharge, physicians were cluster-randomized to an E or a S skills training. Feasibility was measured by training completion rates. Outcomes were measured in patients immediately after discharge, after 7, and 30 days. Primary outcome was patients' immediate recall of discharge information. Secondary outcomes were feasibility of training implementation, patients' adherence to recommendations and satisfaction, as well as the patient-physician relationship. Of 117 eligible physicians, 80 (68.4%) completed the training. Out of 256 patients randomized to one of the two training groups (E: 146 and S: 119) 196 completed the post-discharge assessment. Patients' immediate recall of discharge information was superior in patients in the S-group vs. E-group. Patients in the S-group adhered to more recommendations within 30 days (p = .002), and were more likely to recommend the physician to family and friends (p = .021). No differences were found on other assessed outcome domains. Immediate recall and subsequent adherence to recommendations were higher in the S group. Feasibility was shown by a 69.6% completion rate of trainings. Thus, trainings of discharge information structuring are feasible and improve patients' recall, and may therefore improve quality of care in the ED.

Discharge Communications for Older Patients Between Hospital Healthcare Providers and Home Healthcare Providers: An Integrative Review

The increasing volume of our aging population is dramatically affecting the need for home care services. The discharge process from hospital to home can be fraught with communication challenges if critical information is not provided. The transition process can threaten patient safety and incur adverse patient health outcomes. However, little is known about how the communication occurs between hospital and home health providers. Therefore, this integrative literature review was conducted to (1) describe the discharge communication that is occurring for older patients between hospital and home healthcare providers and (2) summarize the limitations of current discharge communication. A systematic search was conducted using CINAHL, PubMed, Web of Science, and PsycINFO databases. Findings were categorized to address each aim. Seven studies were included for full reviews. Healthcare providers used a variety of communication methods, including: written information, phone calls, or in-person meetings to exchange the discharge information of older patients. Limitations in communications included excessive and incomplete discharge documents, lack of provider’s contact information, lack of trust in each other, and lack of bidirectional communications. The quality of discharge communications can improve by utilizing mediators and implementing standardized discharge documentation requirements. Overall, there was a lack of literature that described the methods and limitations of discharge communication for older patients between hospital and home care services. Further studies can be conducted to generate more evidence. Healthcare providers may improve the quality of discharge communication by addressing the suggested areas.

Patient Satisfaction with a Tertiary Hospital in Egypt using a HCAHPS-Derived Survey.

Study DesignRetrograde cross-sectional study.ObjectiveTo assess patient satisfaction and outcomes in polytraumatized patients in EL-Demerdash hospital.BackgroundThis is the first study that assessed patient satisfaction with a tertiary hospital in Egypt. Ain Shams University Surgery Hospital, which is one of the largest hospitals in Egypt and serves millions of patients each year, was the site of the study.MethodsA version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to query 361 patients from November 2015 until July 2018 Survey questions were divided into the following categories: communication with doctors, responsiveness of hospital staff, cleanliness of the hospital environment, quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of the hospital, and willingness to recommend the hospital.ResultsA total of 361 patients were interviewed. The results showed both positive and negative levels of satisfaction. The positive results included no delay in admission, friendly staff including nurses and doctors, better patient outcomes regarding pain management and adverse side effects, and the overall rating of the hospital was good, which reflected patient satisfaction. The negative findings were lack of proper communication between the medical staff and patients. Patients indicated they did not get a satisfactory explanation of their prescribed drug doses and drug adverse effects. In addition, they did not get enough instruction on what to do after being released from the hospital.ConclusionThe medical staff at Ain Shams University Surgery Hospital should focus more on the patient’s own preferences and communicate better with patients. We recommended that the hospital organize regular communication skills courses for medical students, physicians, and nurses. Patients should understand the discharge report and indications and side effects of the medications before leaving the hospital.

A disease-specific language representation model for cerebrovascular disease research

BackgroundEffectively utilizing disease-relevant text information from unstructured clinical notes for medical research presents many challenges. BERT (Bidirectional Encoder Representation from Transformers) related models such as BioBERT and ClinicalBERT, pre-trained on biomedical corpora and general clinical information, have shown promising performance in various biomedical language processing tasks. ObjectivesThis study aims to explore whether a BERT-based model pre-trained on disease-related clinical information can be more effective for cerebrovascular disease-relevant research. MethodsThis study proposed the StrokeBERT which was initialized from BioBERT and pre-trained on large-scale cerebrovascular disease related clinical text information. The pre-trained corpora contained 113,590 discharge notes, 105,743 radiology reports, and 38,199 neurological reports. Two real-world empirical clinical tasks were conducted to validate StrokeBERT's performance. The first task identified extracranial and intracranial artery stenosis from two independent sets of radiology angiography reports. The second task predicted the risk of recurrent ischemic stroke based on patients’ first discharge information. ResultsIn stenosis detection, StrokeBERT showed improved performance on targeted carotid arteries, with an average AUC compared to that of ClinicalBERT of 0.968 ± 0.021 and 0.956 ± 0.018, respectively. In recurrent ischemic stroke prediction, after 10-fold cross-validation on 1,700 discharge information, StrokeBERT presented better prediction ability (AUC±SD = 0.838 ± 0.017) than ClinicalBERT (AUC±SD = 0.808 ± 0.045). The attention scores of StrokeBERT showed better ability to detect and associate cerebrovascular disease related terms than current BERT based models. ConclusionsThis study shows that a disease-specific BERT model improved the performance and accuracy of various disease-specific language processing tasks and can readily be fine-tuned to advance cerebrovascular disease research and further developed for clinical applications.

A strategy for assessment and validation of major bleeding cases in a primary health care database in Spain.

This study aims to validate major bleeding (MB) cases within a cohort of new users of direct oral anticoagulants (DOACs) in Electronic health records (EHRs) from primary care in Spain (BIFAP), introducing more efficient techniques and automating the process of validation in the pharmacoepidemiologic research with EHR data as much as possible. Registered bleedings were identified in a cohort of new users of DOACs in BIFAP using ICPC 2 and ICD 9 codes; we ascertained these bleedings as MB through a validation strategy based on the MB definition from the International Society on Thrombosis and Hemostasis, which used hospitalization and critical localization as proxies. We assessed hospitalization with hospital discharge information (only available for some years and regions) and a free text-based algorithm created to identify hospitalization in EHR's clinical notes. Incidence rates (IR) of MB were evaluated by bleeding type. The study cohort included 104 614 patients, with 274521.5 p-y of follow up. There were 6143 registered bleedings during the study period (519 intracranial bleeding - ICB, 4606 gastrointestinal bleeding - GIB, 1018 extracranial bleeding - ECB), from which 1679 were confirmed as MB (416 ICB, 1086 GIB, and 177 ECB). The free text-based semi-automatic algorithm had moderate recall (0.59), but high specificity (0.99), and precision (0.94). The combination of hospitalization and critical localization is a valid approach to validate MB in EHRs with incomplete information. The use of more automatic methods for case validation instead of manual review of clinical notes is favored.

Older patients\u2019 perspectives on factors contributing to frequent visits to the emergency department: a qualitative interview study

BackgroundOlder patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to describe older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits.MethodsThis was a qualitative description study. We performed semi-structured individual interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached.ResultsIn-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit.ConclusionsThis qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.

Recall and Understanding of Discharge Information in Observation Ward Patients: An Explorative Observational Study

Effective communication is essential for understanding and recall of hospital discharge information. This study aimed to explore discharge information, patient recall and patient involvement in discharge encounters. We conducted an explorative observational study at a secondary care level, observational ward. Patients discharged to their home were asked to participate. 34 patients were assessed for eligibility, of which 13 were included in the analysis. Multiple sources of data were collected: videotapes of discharge encounters, questionnaires to patients and physicians, and semi-structured interviews with patients 2 weeks after discharge. All patients were satisfied with the information received. Five of the eight patients discharged with more than one change in medication had only partial or no recall of these changes. In seven of the 13 encounters the patients and physicians did not agree on the main message most important information item. The patients were to a small extent involved in decision-making. Our findings highlight the gaps in the information exchange at discharge encounters and the resulting poor information recall among patients. Patients do not seem aware of these gaps. Greater provider awareness of patient involvement in the encounter and inclusion of the patient’s perspective may improve communication, and consequently understanding and recall.