Hospital Discharge Transitions Research Articles

Emerging lessons from experiences at transitions in care among hospitalised patients with cancer with postdischarge frequent emergency department use: a qualitative study using linked clinical and patient-reported interview data from Quebec, Canada

BackgroundWhile teamwork is essential to providing high-quality patient-centred care, challenges in interprofessional collaboration and decision-making in hospital settings are common, especially for patients with cancer. The purpose of this qualitative...

Care Home Safety Incidents and Safeguarding Reports Relating to Hospital to Care Home Transitions: A Retrospective Content Analysis.

The purpose of this study was to further the understanding of reported patient safety events at the interface between hospital and care home including what active failings and latent conditions were present and how reporting helped learning. Two care home organizations, one in the North East and one in the South West of England, participated in the study. Reports relating to a transition and where a patient safety event had occurred were sought during the COVID-19 (SARS-CoV-2) virus prepandemic and intrapandemic periods. All reports were screened for eligibility and analyzed using content analysis. Seventeen South West England care homes and 15 North East England care homes sent 114 safety incident reports and after screening 91 were eligible for review. A hospital discharge transition (n = 78, 86%) was most common. Pressure damage (n = 29, 32%), medication errors (n = 26, 29%) and premature discharge (n = 21, 23%) contributed to 84% of the total reporting. Many 'active failings' (n = 340) were identified with fewer latent conditions (failings) (n = 14, 15%) being reported. No examples of individual learning were identified. Organization and systems learning were identified in 12 reports (n = 12, 13%). The findings highlight potentially high levels of underreporting. The most common safety incidents reported were pressure damage, medication errors, and premature discharge. Many active failings causing numerous staff actions were identified emphasizing the cost to patients and services. Additionally, latent conditions (failings) were not emphasized; similarly, evidence of learning from safety incidents was not addressed.

Perspectives of family caregivers and nurses on hospital discharge transitional care for Muslim older adults living with COPD: a qualitative study

BackgroundThe increased number of emergency department visits among older adults living with chronic obstructive pulmonary disease reflects the challenges of hospital discharge transition, especially in those from a cultural minority. The barriers and facilitators of this discharge from the perspective of formal and informal care providers, such as nurses and family caregivers, are important to identify to provide effective symptom management and quality of care. The purpose of this study was to describe the barriers and facilitators in caring for Muslim older adults with chronic obstructive pulmonary disease (COPD) during hospital discharge transitional care.MethodsA descriptive qualitative study was conducted in a hospital of Thailand where Muslim people are a cultural minority. Thirteen family caregivers of Muslim older adults living with COPD and seven nurses were purposively recruited and participated in semi-structured interviews and focus group discussions. Content analysis was used to analyze the data.ResultsFive barriers and three facilitating factors of transitional care for Muslim older adults living with COPD were outlined. Barriers included: (1) lack of knowledge about the causes and management of dyspnea, (2) inadequate discharge preparation, (3) language barrier, (4) discontinuity of care, and (5) COVID-19 epidemic. Facilitators included: (1) the ability to understand Malayu language, (2) the presence of healthcare professionals of the same gender, and (3) the presence of Muslim healthcare providers.ConclusionFamily caregivers require more supportive care to meet the care needs of Muslim older adults living with COPD. Alternative nurse-based transitional care programs for these older adult caregivers should be developed.

Abstract 3468: Emerging lessons from patient-reported hospital discharge experiences among hospitalized cancer patients with frequent emergency department use

Abstract Background: While teamwork is essential to providing high-quality patient-centered care, challenges in interprofessional collaboration and decision-making in the hospital settings are common, especially for cancer patients. The purpose of this study was to identify emerging themes related to hospital discharge experiences among patients hospitalized for cancer who became frequent emergency department (ED) users following their hospital discharge. Design & Methods: A cohort of cancer patients discharged from an academic health center in Montreal (Canada) between October 2014 and November 2016 was assembled. Frequent ED (FED) users were identified as patients who had a > 4 ED visits in the year following hospital discharge using health administrative claims from the provincial universal health care program. Qualitative analysis of telephone interviews conducted with patients 30 days’ post-discharge were used for in-depth exploratory analyses to characterize hospital discharge experiences and transition process from the hospital to the community. Results: A cohort of 1253 cancer patients was formed. The mean age was 70.9 (SD=11.8) and the most frequent cancers included 488 (38.9%) respiratory and 309 (24.6%) upper digestive cancer. Overall, 14.5% (n=182) of patients became FED users. Content analyses revealed the most common emerging themes from the FED patients interviews on hospital discharge experiences. These included:1. Early hospital discharge putting patients at high risk of being re-admitted and going back to the ER shortly after that. Some patients mentioned post-discharge complications and emerging of new health issues that could have been avoided if patient was kept in the hospital for longer.2. Lack of communication between different specialists at the hospital. Some patients mentioned the help of a nurse as crucial during inpatient stays in maintaining communication between doctors. 3. Lack of communication of medications prescribed. Some patients mentioned the lack of communication of what doses was modified, what medications were stopped and which ones were newly prescribed.4. The need to schedule follow-up appointments at the time of hospital discharge. This becomes especially important for vulnerable patients who have been on pain medication during the hospital stay, affecting their cognitive abilities and making post-discharge planning more difficult. Conclusions: This study using integrated data from administrative claims and patient interviews provided insights into the challenges related to hospital discharge experiences and transition into community among hospitalized cancer patients with frequent emergency department use. Application of our findings could assist in hospital discharge preparation and improvement in healthcare delivery and health outcomes. Citation Format: Siyana Kurteva, Robyn Tamblyn. Emerging lessons from patient-reported hospital discharge experiences among hospitalized cancer patients with frequent emergency department use [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3468.

Nursing Checklist of Home Care Guidelines for Informal Caregivers in the Hospital Discharge Transition

Introduction: The use of pre-discharge tools enables the nursing team to guide informal caregivers, promoting continued care at home, which can minimize readmissions. Objective: To develop and validate a checklist to support the nursing team in guiding informal caregivers regarding home care during the discharge transition process. Materials and Methods: This is a methodological study, submitted to 14 nurse judges, who evaluated a checklist on care guidelines for informal caregivers in the hospital discharge transition. The study was performed in three stages: A literature review, the development of the checklist, and validation using the Delphi technique, which was conducted from February 2022 to January 2023, and the data was treated using scale reliability analysis, a content validity index, and an intraclass correlation coefficient. Results: The checklist was comprised of 10 domains: Hygiene and comfort; tracheostomy; oxygen therapy; nutrition; indwelling urinary catheter; ostomies; dressings; risk of falls; medication; returns and referrals, totaling 32 guidelines for informal caregivers. The checklist was submitted to two validation stages and, after implementing the changes suggested by the judges, a content validity index of 100% agreement was obtained between the evaluators, with a Cronbach’s Alpha of 0.84 and an intraclass correlation index of 0.80. Conclusions: The checklist presents good reliability, intraclass correlation, and content validation, and can be applied in professional practice and scientific settings regarding the transition to hospital discharge of critically ill patients, helping to promote continued care at home.

Efficacy of a Hospital Discharge Transition Plan in the care competence of patients with chronic conditions and their family caregivers: a clinical trial

Objetivo: evaluar la eficacia del Plan Transicional de Alta Hospitalaria en la competencia para el cuidado y adherencia terapéutica de la díada paciente-cuidador con enfermedad crónica no transmisible. Método: ensayo clínico aleatorizado controlado; la muestra estuvo conformada por 80 diadas paciente-cuidador con condición crónica asignadas aleatoriamente, 40 diadas al grupo control y 40 al grupo intervención. Se aplicaron los instrumentos de caracterización de la díada paciente-cuidador, competencia para el cuidado del paciente y cuidador y la escala de adherencia al tratamiento del paciente. Se realizó la “Intervención Educativa Cuidemos” al grupo intervención y al grupo control se le brindaron los cuidados habituales con ayuda de un folleto; con seguimiento telefónico al mes. Resultados: el 52,5% de los pacientes son mujeres al igual que el 81,3% de los cuidadores. El promedio de edad en pacientes y cuidadores es de 69,5±12,6 y 47,5±13,1 años. El Plan Transicional de Alta Hospitalaria aumentó los puntajes de las dimensiones, conocimiento, unicidad, instrumental, disfrutar, anticipación y relación y la competencia global del cuidado del paciente y cuidador familiar. También, los factores medicamentos, dieta, control de estimulantes, control del peso, manejo del estrés y la adherencia terapéutica global del paciente. No hubo diferencias estadísticamente significativas entre el grupo control e intervención. Conclusión: el Plan Transicional de Alta Hospitalaria aumenta la competencia para el cuidado del paciente y cuidador familiar post intervención, y también la adherencia del paciente. Sin embargo, no hubo diferencias entre el grupo intervención y control, posiblemente debido a la semejanza de las actividades.

Efficacy of a Hospital Discharge Transition Plan in the care competence of patients with chronic conditions and their family caregivers: a clinical trial.

to assess the efficacy of a Hospital Discharge Transition Plan in the care competence and in adherence to the therapy of dyads comprised by patients with non-communicable chronic diseases and their caregivers. a controlled and randomized clinical trial; the sample was comprised by 80dyads of patients with chronic conditions and their caregivers, randomly allocated as follows: 40 to the control group and another 40 to the intervention group. The instruments to characterize the patient-caregiver dyad, the patients' and caregivers' care competence and the patients' adherence to the treatment scale were applied. The " CUIDEMOS educational intervention" was applied to the intervention group; in turn, the control group was provided usual care with the aid of a booklet, with phone follow-up via at month1. 52.5% of the patients and 81.3% of the caregivers were women. The patients' and caregivers' mean ages were 69.5±12.6 and 47.5±13.1years old, respectively. The Hospital Discharge Transition Plan increased the scores in the "knowledge", "uniqueness", "instrumental", "enjoying", "anticipation" and "social relations" dimensions, as well as the global care competence of the patients and family caregivers; in addition to the following factors: medications, diet, stimulants control, weight control, stress management, and global adherence to the therapy by the patient. There were no statistically significant differences between the control and intervention groups. the Hospital Discharge Transition Plan increased the patients' and family caregivers' care competence after the intervention, as well as the patients' adherence to the treatment. However, there were no differences between the control and intervention groups, possibly due to the similarity of the activities.

Efficacy of a Hospital Discharge Transition Plan in the care competence of patients with chronic conditions and their family caregivers: a clinical trial

Objetivo: avaliar a efetividade do Plano Transicional de Alta Hospitalar na competência para o cuidado e adesão terapêutica da díade paciente-cuidador com doença crônica não transmissível. Método: ensaio clínico randomizado controlado; a amostra foi composta por 80 díades paciente-cuidador com condição crônica distribuídas aleatoriamente, sendo 40 díades para o grupo controle e 40 para o grupo intervenção. Foram aplicados os instrumentos de caracterização da díade paciente-cuidador, competência do cuidar de pacientes e cuidadores e escala de adesão ao tratamento do paciente. No grupo intervenção foi realizada a “ Intervención Educativa Cuidemos ” e no grupo controle foram prestados os cuidados habituais, com auxílio de folheto; com acompanhamento telefônico após um mês. Resultados: 52,5% dos pacientes são mulheres, assim como 81,3% dos cuidadores. A idade média dos pacientes e cuidadores é de 69,5±12,6 e 47,5±13,1 anos. O Plano Transicional de Alta Hospitalar aumentou os escores das dimensões conhecimento, singularidade, instrumentalidade, desfrutar, antecipação e relação e competência global do cuidado ao paciente e cuidador familiar. Também os fatores medicamentos, dieta, controle de estimulantes, controle de peso, gerenciamento de estresse e adesão terapêutica geral do paciente. Não houve diferenças estatisticamente significativas entre os grupos controle e intervenção. Conclusão: o Plano Transicional de Alta Hospitalar aumenta a competência para o cuidado do paciente e do cuidador familiar pós-intervenção, e também a adesão do paciente. Porém, não houve diferenças entre os grupos intervenção e controle, possivelmente pela semelhança das atividades.

Social inequality in navigating the healthcare maze: Care trajectories from hospital to home via intermediate care for older people in Norway

Although health inequality is a growing concern, striking differences in health and life expectancy still exist across and within OECD countries. In Oslo, the largest city in Norway, life expectancy differs by up to 7 years between districts. Equal access to healthcare can help reduce social differences in health. However, research indicates that older people at the lower level of the social gradient have more difficulty accessing health services. Older people experience early hospital discharge and several transitions between and across care levels. In this study, using Bourdieu's theory of practice as a theoretical lens, we explore social inequality in access to universal healthcare within care trajectories for older people in Oslo. Through observation of family meetings in intermediate care (N = 14) and semi-structured interviews with older patients (N = 15), informal caregivers (N = 12) and healthcare professionals (N = 18), the study identifies 15 unique care trajectories from hospital to home via intermediate care. Informed by a critical realist perspective and moving from west to east via the urban areas, there is a prominent finding of climbing down the social gradient and, subsequently, reduced access to healthcare. An overarching theme, ‘Navigating the healthcare maze’, was identified along with two subthemes: ‘Individuality meets system’ and ‘Having a feel for the game’. Navigating the healthcare maze depends on where you live, your level of education and health literacy and the ability to mobilize social networks. Furthermore, it is an advantage to fit into the professional habitus of the ‘active patient’ discourse. The findings will be relevant for politicians, managers, healthcare professionals and other stakeholders working in the field and in the development of services adapted to the needs of various socioeconomic groups.

Adapting Contingency Management for Hospitalized Patients with Stimulant Use Disorder.

Hospitals struggle to engage patients with stimulant use disorders, and little is known about how to adapt evidence-based behavioral interventions, such as contingency management (CM), for hospital settings. Our study is the first step in informing the design of a hospital CM intervention. We performed a qualitative study at a quaternary referral academic medical center in Portland, Oregon. We conducted semistructured qualitative interviews with CM experts, hospital staff, and hospitalized patients, eliciting input about hospital CM adaptations, anticipated challenges, and potential opportunities. We performed a reflexive thematic analysis at a semantic level and shared results for respondent validation. We interviewed 8 CM experts (researchers and clinicians), 5 hospital staff, and 8 patients. Participants felt CM could benefit hospitalized patients by supporting patient substance use disorder and physical health goals, especially by addressing the boredom, sadness, and loneliness of hospitalization. Participants emphasized that in-person interactions could improve patient-staff relationships by using "super positive" experiences to improve rapport. For successful hospital CM, participants emphasized CM core concepts and potential hospital adaptations, including identifying hospital-specific high-yield target behaviors, ensuring staff training, and using CM to support the hospital discharge transition. Participants also encouraged considering novel mobile app interventions, which may offer more flexibility in the hospital, recommending that such interventions include an in-person CM facilitator. Contingency management has potential to support hospitalized patients and improve patient and staff experience. Our findings can inform CM interventions for hospital systems seeking to expand access to CM and stimulant use disorder treatment.

The effect of sensorimotor interventions on feeding readiness and oral feeding success in preterm infants: a randomized controlled trial

ABSTRACT Aim This study aimed to examine the effect of sensorimotor interventions (SI) on feeding readiness and oral feeding success in preterm infants. Method A parallel, prospective, and randomized controlled study. The study data were collected between 1 June 2020–1 June 2021 and study sample comprised 60 preterm infants with a gestational age of 30–33 weeks. A combined sensorimotor intervention, including Tactile/Kinesthetic Stimulation + Non-nutritive sucking (NNS), was applied to the intervention group. The Control group applied only a SI as NNS. Results T-POFRAS feeding readiness scores were higher in the intervention group (p = 0.000). The feeding success level of the intervention was higher. Although hospital discharge time and transition to full breastfeeding of the intervention group were shorter, it was not statistically significant (p = 0.078). Conclusion It was found that combined SIs were effective in enhancing oral feeding readiness and feeding success levels in preterm infants.

How to improve medication safety at hospital discharge: let’s get practical

The hospital discharge transition is a well-known risk factor for medication-related harm. The Royal College of Physicians have created an improvement guide and resource, focusing on medication safety at hospital discharge. In this article, we discuss how we developed this resource and explore some of the lessons learnt, including the importance of involving patients and carers; understanding the discharge medicines system; appreciating everyone's roles; measuring medication safety, project spread and sustainability; and the pros and cons of a virtual working environment.

Implementation and Evaluation of a Team-Based Approach to Hospital Discharge Transition of Care.

Transitional care management (TCM) programs guide patients from hospital discharge to outpatient follow-up with the goal to decrease hospital readmissions and the cost of care. In 2017, the department of primary care internal medicine (PCIM) at Eastern Virginia Medical Group implemented TCM. We aimed to evaluate the efficacy and self-sustainability of this TCM program. The TCM team contacted patients upon discharge to schedule the follow-up appointment. We coded patient contact as (1) no successful phone-call contact, patient did not attend appointment; (2) successful phone-call contact, patient did not attend appointment; and (3) patient attended appointment. We collected patient demographics, readmissions, and visit costs using manual chart review and electronic health record (EHR) data extraction. We conducted χ 2 analysis, one-way analysis of variance, and unpaired t tests to assess associations between readmission rates or costs and TCM care. Initial analysis did not indicate significant associations between readmission rates and level of TCM care at 30 (χ 2=1.40, P=.50), 60 (χ 2=5.48, P=.06), or 90 (χ 2=4.23, P=.12) days or significant differences in patient charges at 30 (F[2,59]=2.85, P=.06), 60 (F[2,91]=2.00, P=.14), or 90 (F[2,126]=1.39, P=.25) days. Follow-up analysis indicated significant associations between readmission rates and any level of TCM care at 60 (χ 2=5.40, P=.02) and 90 (χ 2=4.21, P=.04) days, but not at 30 days (χ 2=1.39, P=.28). Our TCM program review suggests that the benefits of transitional care extend beyond 30 days by decreasing readmission rates at 60 and 90 days after hospital discharge.

CARE TRANSTION IN HOSPITAL DISCHARGE FOR ADULT PATIENTS: INTEGRATIVE LITERATURE REVIEW

ABSTRACT Objective: to summarize and analyze the scientific production on care transition in the hospital discharge of adult patients. Method: integrative review, conducted from May to July 2020, in four relevant databases in the health area: Public Medline (PubMed); Scientific Electronic Library Online (SciELO); Scopus and Virtual Health Library (VHL). The analysis of the results occurred descriptively and was organized into thematic categories that emerged according to the similarity of the contents extracted from the articles. Results: 46 articles from national and international journals, with a predominance of descriptive/non-experimental studies or qualitative studies, met the inclusion criteria. Five categories were identified: discharge and post-discharge process; Continuity of post-discharge care; Benefits of care transition; Role of nurses in care transition and Experiences of patients on care transition. Hospital discharge and care transitions are interconnected processes as transitions qualify the dehospitalization process. Different strategies for continuity of care should be adopted, as they offer greater safety to the patient. Studies have shown that nurses play a fundamental role in transitions and, in Brazil, this activity still needs to gain more space. Reduced hospitalizations, mortality, hospital costs and patient satisfaction are benefits of transitions. Conclusion: care transition is an effective strategy for the care provided to the patient being discharged. It points out the need for integration between the care network and assists services in decision-making about the continuity of care on discharge.

Bridging to value with codes that promote care management.

Transitional care management (TCM) and chronic care management (CCM) fee-for-service billing codes can serve as bridges to help organizations build care management capabilities and effectively transition from volume- to value-based care. TCM codes encourage providers to build capabilities for managing hospital discharge transitions. CCM codes encourage physician and nonphysician staff to build capabilities for longitudinally managing patients with multiple chronic conditions. Implementation challenges include achieving return on investment in health information technology and securing stakeholder commitment and engagement. Nonetheless, policy makers have reinforced their commitment to these codes, offering an encouraging signal for organizations seeking more gradual ways to build competencies and bridge toward value-based payment and care delivery.

How to Enhance Digital Support for Cross-Organisational Health Care Teams? A User-Based Explorative Study.

Health care service provision of individualised treatment to an ageing population prone to chronic conditions and multimorbidities is threatened. There is a need for digitally supported care, that is, (1) person-centred, (2) integrated, and (3) proactive. The research project 3P, Patients and Professionals in Productive Teams, aimed to validate and verify the prerequisites for health care systems run with patient-centred service models. This paper presents an explorative study of the digital support of a cross-organisational health care team in Norway, providing services to elderly frail people with multimorbidities in hospital discharge transition. Qualitative research methods were employed, with interviews and observations to map and evaluate the information flow and the digital support of collaborative work across organisations. The evaluation showed a lacking interoperability between the digital systems and a limited support for cross-organisational teamwork, causing raised manual efforts to maintain the information flow. Tools for coordination and planning across organisations were lacking. To enhance the situation, principles for a cloud-based health portal are proposed with a shared workspace, teamwork functionality for cross-organisational health care teams, and automatic back-end synchronisation of stored information. The main implications of this paper lie in the proposed principles which are transferable to a multitude of clinical contexts, where ad-hoc based access to shared medical information is of importance for decision-making and life-saving treatment.

Multiyear Outcomes of a Population-Oriented Care Redesign in an Internal Medicine Residency Continuity Clinic.

The cornerstone of ambulatory care training for internal medicine residents is the continuity clinic, which often serves medically and psychosocially complex patients. We conducted and evaluated a population-oriented redesign to improve care for "high-needs" patients and the resident experience at a hospital-based safety net primary care internal medicine practice in the Southeastern U.S. A Define, Measure, Analyze, Implement, Control (DMAIC) framework was adapted to identify and develop three main interventions to address major unmet needs of patients and trainees: (1) a behavioral health-focused team care model; (2) a formalized hospital discharge transitions workflow; and (3) the creation of larger "firms" of smaller resident practice partnerships. We constructed a financial model to justify investments, with metrics to track progress. Over three years, sustained reductions in hospitalizations and ED visits (mean annual changes of -11.6% and -16.9%, respectively) were achieved. Resident primary care provider (PCP)-to-patient continuity and satisfaction also improved.

Lost in Transition: Pharmacist Roles in Identifying and Evaluating Medication-Related Problems During Hospital Discharge Follow-up Visits in a Primary Care Setting.

Objectives: The objective of this study was to identify and evaluate medication-related problems (MRPs) found during hospital discharge transitions of care visits in a primary care setting. Design, Settings, and Participants: This retrospective cohort took place within a federally qualified health center (FQHC) where pharmacists are part of the interprofessional transitions of care team to help patients transition back to primary care after being discharged from the hospital. Pharmacists utilized standardized forms to document MRPs, potential and adverse drug events, and interventions made during the visit. This study quantifies the role that pharmacists can have by conducting medication reconciliation during postdischarge primary care visits. Patients included in this study were 18 years and older with at least 5 medications. Outcome Measures: The outcomes of this study include the number and type(s) of MRPs, number and severity of potential adverse drug events (pADEs) and adverse drug events (ADEs) that were identified, as well as the number and type of recommendations or interventions made by the pharmacist. The MRP types and pADE/ADE severity were classified and stratified using predetermined definitions. Results: During the 4-month study period from October 1, 2018 to February 4, 2019, 134 visits were completed. Outcomes included a total of 454 MRPs, with an average of 3 identified per visit. The most common MRPs were medication list in electronic health record inaccurate (79.1% of visits), poor adherence (32.1% of visits), and refills needed (30.6% of visits). A total of 72 pADEs and 27 ADEs were identified, with 524 recommendations made. Conclusion: Pharmacists serve a unique role during transitions of care by identifying MRPs. Pharmacists are an integral part of a patient’s health care team by making recommendations or interventions related to these MRPs. FQHCs and other primary care settings should consider integrating pharmacists into a collaborative transitions of care team.

Patient-Reported Quality of Hospital Discharge Transitions: Results from the SILVER-AMI Study.

Transitions from hospital to home in older patients are a high-risk period for adverse outcomes in a population that may have more challenges navigating the healthcare system. There is little information about the association of patient-reported quality of hospital discharge processes with clinical outcomes. We evaluated whether patient-reported quality of hospital discharge processes was associated with emergency department utilization and rehospitalization within 30 days of discharge after hospitalization for acute myocardial infarction (AMI) in older adults. Multi-center, prospective cohort study. The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study was a longitudinal study of 3006 adults age 75 and older hospitalized with AMI recruited from 94 academic and community hospitals from across the USA. N/A MAIN MEASURES: Patients answered a subset of questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Readmissions and emergency department utilization within 30 days of discharge were ascertained through medical record review. A total of 2132 patients were included in the study. Patients' median age was 81 years and the response rate to the survey of discharge quality was 87%. Patients who reported being asked about having the help they needed at home were significantly less likely to have emergency room utilization within 30 days of discharge in both the unadjusted (0.65, 95% CI 0.43-0.99) and adjusted (0.65, 95% CI 0.42-0.997) models, though there was no significant association with readmission. Report of an assessment of help needed at home during hospitalization was associated with lower post-discharge emergency department utilization. Efforts to improve outcomes after hospital discharge in older patients may benefit from greater focus on assessing need of help at home.

Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres

BackgroundChallenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences. MethodsA qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach. ResultsTwenty-four interviews included 19 patients and 7 family members. Participants’ experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities’ ability to care for injured patients. ConclusionsThe quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients encounter complex barriers to quality discharge that likely require a comprehensive, multimodal intervention.