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Information Received at Discharge

Best Practices

Created on November 15, 2017

“Insanity is doing things the way we’ve always done them and expecting different results.”
Albert Einstein

Patient experience: Did you receive enough information when you left the hospital? is a priority indicator for the Quality Improvement Plans (QIPs). This indicator measures the percentage of discharged patients who responded positively to the following question: Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?

Below are best practices for managing and improving this indicator. They are graded according to Type of Evidence. Evidence-informed best practices are based on high-quality evidence; they can optimize outcomes and should be implemented into practice where possible.

To help you move from best evidence to best practice, you can refer to PODS: Patient Oriented Discharge Summary which is supported by ARTIC, CAHO, Health Quality Ontario and UHN Open Lab. Or browse the interactive table below for a quick summary and change ideas on how to improve patient experience related to the information received at discharge.

  1. Al-Damluji M.S; Dzara K; Hodshon B; Punnanithinont N; Krumholz H.M; Chaudhry S.I; Horwitz L.I.(2015).
    Hospital variation in quality of discharge summaries for patients hospitalized with heart failure exacerbation.
    Circulation. Cardiovascular Quality & Outcomes. 8(1):77-86.

  2. Apkon M., Friedman J.N. (2014).
    Planning for effective hospital discharge.
    JAMA Pediatrics. 168(10):890-891.

  3. Borgsteede S.D; Karapinar-Carkit F; Hoffmann E; Zoer J; van den Bemt P.M. (2011).
    Information needs about medication according to patients discharged from a general hospital.
    Patient Education & Counseling. 83(1):22-28.

  4. Bucaro P.J; Black E. (2014).
    Facilitating a safe transition from the pediatric emergency department to home with a post-discharge phone call: a quality-improvement initiative to improve patient safety.
    Journal of Emergency Nursing. 40(3):245-252.

  5. Buurman, B.M., Verhaegh, K.J., et al. (2016). Improving handoff communication from hospital to home: the development, implementation and evaluation of a personalized patient discharge letter. International Journal of Quality in Health Care, 28(3): 384–390.

  6. Caceres J.W; Alter S.M; Shih R.D; Fernandez J.D; Williams F.K; Paley R; Benda W; Clayton LM.(2017).
    Standardized Physician-Administered Patient-Centered Discharge Protocol Improves Patients' Comprehension.
    Southern Medical Journal. 110(5):359-362.

  7. Chidwick P; Sibbald R.W; Hansen T.L; Parkes C. (2013).
    Managing access and flow through appropriate discharge: preventing common errors and improving processes.
    Healthcare Quarterly. 16(4):43-48.

  8. Committee on Health Literacy.
    Board on Neuroscience and Behavioral Health. Institute of Medicine.
    Health literacy: a prescription to end confusion.
    Washington, DC: National Academies Press; 2004.
    Available from: http://www.collaborationhealthcare.com/7-20-10IOMHealthLiteracyExecutiveSummary.pdf.

  9. Fagermoen M.S; Hamilton G. (2006).
    Patient information at discharge--a study of a combined approach.
    Patient Education & Counseling. 63(1-2):169-176.

  10. Gamble K; Abate S; Seibold M; Wenzel K; Ducharme J. (2011).
    Promoting readiness for discharge for long-term state hospital residents.
    Psychiatric Rehabilitation Journal. 35(2):133-136.

  11. Garvin J.H; Elkin P.L; Shen S; Brown S; Trusko B; Wang E; Hoke L; Quiaoit Y; Lajoie J; Weiner M.G; Graham P; Speroff T. (2013).
    Automated quality measurement in Department of the Veterans Affairs discharge instructions for patients with congestive heart failure.
    Journal for Healthcare Quality. 35(4):16-24.

  12. Hahn-Goldberg S., Solomon R., Okrainec K., Huynh T., Zahr N., Abrams H. (2015).
    Co-creating patient-oriented discharge instructions with patients, caregivers, and healthcare providers.
    Journal of Hospital Medicine, 10 (12): 804–807.

  13. Hahn-Goldberg S., Damba C., Solomon R., Okrainec K., Abrams H., Huynh T. (2016).
    Using Co-Design Methods to Create a Patient-Oriented Discharge Summary.
    Journal of Clinical Outcomes Management. 23 (7).

  14. Hesselink G; Schoonhoven L; Plas M; Wollersheim H; Vernooij-Dassen M. (2013).
    Quality and safety of hospital discharge: a study on experiences and perceptions of patients, relatives and care providers.
    International Journal for Quality in Health Care. 25(1):66-74.

  15. Horwitz L.I; Moriarty J.P; Chen C; Fogerty R.L; Brewster U.C; Kanade S; Ziaeian B; Jenq G.Y; Krumholz H.M. (2013).
    Quality of discharge practices and patient understanding at an academic medical center.
    JAMA Internal Medicine. 173(18):1715-1722.

  16. Jack BW, Chetty VK, Anthony D, et al. (2009).
    A reengineered hospital discharge program to decrease rehospitalisation: a randomized trial.
    Annals of Internal Medicine; 150 (3): 178–187

  17. Lithner M; Jakobsson U; Andersson E; Klefsgard R; Palmquist I; Johansson J. (2015).
    Patients' Perception of Information and Health-Related Quality of Life 1 Month After Discharge for Colorectal Cancer Surgery.
    Journal of Cancer Education. 30(3):514-521.

  18. Monfort A.S; Curatolo N; Begue T; Rieutord A; Roy S. (2016).
    Medication at discharge in an orthopaedic surgical ward: quality of information transmission and implementation of a medication reconciliation form.
    International Journal of Clinical Pharmacy; 38(4):838-847.

  19. Moro Agud M; Menendez Colino R; Mauleon Ladrero Mdel C; Ruano Encinar M; Diez Sebastian J; Villamanan Bueno E; Herrero Ambrosio A; Gonzalez Montalvo J.I. (2016).
    Analysis of an electronic medication reconciliation and information at discharge programme for frail elderly patients.
    International Journal of Clinical Pharmacy. 38(4):996-1001.

  20. New P.W; McDougall K.E; Scroggie C.P. (2016).
    Improving discharge planning communication between hospitals and patients.
    Internal Medicine Journal. 46(1):57-62

  21. Okrainec K., Lau, D. et al. (2017).
    Impact of patient-centered discharge tools: A systematic review.
    Journal of Hospital Medicine 12 (2): 110 – 117.

  22. Oterhals K; Hanestad B.R; Eide G.E; Hanssen T.A. (2006).
    The relationship between in-hospital information and patient satisfaction after acute myocardial infarction.
    European Journal of Cardiovascular Nursing. 5(4):303-310.

  23. Petitgout J. M. (2015).
    Implementation and Evaluation of a Unit-Based Discharge Coordinator to Improve the Patient Discharge Experience. [Review].
    Journal of Pediatric Health Care. 29(6):509-517.

  24. Rootman I, Gordon-El-Bihbety D. (2008).
    A vision for a health literate Canada: report of the Expert Panel on Health Literacy.
    Retrieved from: http://www.cpha.ca/uploads/portals/h-l/report_e.pdf.

  25. Schuller K.A; Lin S.H; Gamm L.D; Edwardson N. (2015).
    Discharge phone calls: a technique to improve patient care during the transition from hospital to home.
    Journal for Healthcare Quality. 37(3):163-172.

  26. Sheridan S, Halpern D, Viera A, Berkman N, Donahue K, Crotty K. (2011).
    Interventions for individuals with low health literacy: a systematic review.
    Journal of the Health Community; 16:30–54.

  27. Shoeb M; Merel S.E; Jackson M.B; Anawalt B.D. (2012).
    "Can we just stop and talk?" patients value verbal communication about discharge care plans.
    Journal of Hospital Medicine (Online). 7(6):504-507.

  28. Singh G; Harvey R; Dyne A; Said A; Scott I. (2015).
    Hospital discharge summary scorecard: a quality improvement tool used in a tertiary hospital general medicine service.
    Internal Medicine Journal. 45(12):1302-1305.

Measurement

Created on November 15, 2017

“While all changes do not lead to improvement, all improvement requires change”
Institute for Healthcare Improvement

How do we know if a change is an improvement? Measurement is a critical step in QI to assess the impact of a change. Quality indicators are used in the QIPs to measure how well something is performing. There are three types of quality indicators used to measure QI efforts:

  • Outcome Indicators: capture clinical outcomes and or system performance,
  • Process Indicators: track the processes that measure whether the system is working as planned, and
  • Balancing Indicators: ensure that changing one part of the system does not cause new problems in another.

Indicator

Patient experience: Did you receive enough information when you left the hospital?

Topic Patient Reported Measures, Readmission
Quality Dimension Effective
Type of Indicator Outcome
Measure Percentage (%)
Data Source Canadian Patient Experiences Survey-Inpatient Care (CPES-IC) Question 38.
Data Collection Instrument In-house data collection. These data should be accessed from within your own organization.
How to Calculate

The percentage is calculated as: (Numerator/Denominator) x 100

Numerator: # of respondents who responded "Completely"

Denominator: # of respondents who registered any response to this question.

See the Indicator Library for specifics on calculating this indicator.

Target Higher is better
Range 0 – 100%
HQO Reporting Tool Quality Improvement Plans (QIPs)

This data can be presented using Run Charts to track improvement over time. To read more about general measurement in QI refer to Measurement for Quality Improvement or the QI Getting Started Section.

Background

Created on November 15, 2017

Issue

Hospital discharge is a complex process involving a team of health care providers including, but not limited to; physicians, nurses, dietitians, physical therapists, social workers and care coordinators. The discharge and aftercare planning process begins at admission and continues throughout a patient's hospital stay. Ineffective discharge planning without sufficient information and lack of coordination of care can lead to decreased patient satisfaction, adverse events (AEs) and a higher number of hospital readmissions due to complications (Buurman et al., 2016). One problem that can be exacerbated when enough information isn’t given at discharge is medication errors and/or discrepancies (Wong et al. 2008). Studies show that adverse events with medication, an others can result from ineffective communication, limited patient literacy for reading drug labels or inability to recall medical instructions (PODS, 2017).

Traditional discharge summaries are generally written in a provider-centric manner for the primary care provider who is taking over care from the hospital to the community (Hahn-Goldberg, et al., 2016). Failure to provide complete discharge instructions can result in non-adherence to patient treatment regimens and lack of essential follow-up, the most commonly identified reasons for readmissions (Lyerly Lingle, 2013). Tools to support communication between the clinician and patient regarding instructions for patients to follow at home post discharge are lacking and a more patient centered version of typical discharge summaries is needed to complement the traditional format (Hahn-Goldberg, et al., 2016).


Call to Action

Improving patient engagement through the use of media, visual aids, or by involving patients when creating or delivering a discharge tool improves comprehension and retention of medical information and instructions following hospital discharge (Okrainec et al., 2017). Co-design events are very useful for engaging patients and caregivers in the design and development of solutions aimed at improving their experience of care during discharge from the hospital and providing useful appropriate information for transition from hospital to the home / community (Hahn-Goldberg et al., 2016).

  1. Buurman, B.M., Verhaegh, K.J., et al. (2016).
    Improving handoff communication from hospital to home: the development, implementation and evaluation of a personalized patient discharge letter.
    International Journal of Quality in Health Care, 28(3): 384–390.

  2. Hahn-Goldberg S., Damba C., Solomon R., Okrainec K., Abrams H., Huynh T. (2016).
    Using Co-Design Methods to Create a Patient-Oriented Discharge Summary.
    Journal of Clinical Outcomes Management. 23 (7):

  3. Lyerly Lingle C. (2013).
    Evidence Based Practice: Patient Discharge, Education Barriers to Patient Education.
    Thesis and Capstone Project, Gardner-Webb University.
    Retrieved from: http://digitalcommons.gardner-webb.edu/cgi/viewcontent.cgi?article=1066&context=nursing_etd

  4. Okrainec K., Lau, D. et al. (2017).
    Impact of patient-centered discharge tools: A systematic review.
    Journal of Hospital Medicine 12 (2): 110 – 117.

  5. Patient Oriented Discharge Summary PODS (2017).
    Understand Q&A Webpage.
    Retrieved from: http://pods-toolkit.uhnopenlab.ca/

  6. Wong J., Bajcar JM., et al. (2008).
    Medication Reconciliation at Hospital Discharge: Evaluating Discrepancies.
    The Annals of Pharmacotherapy; 42 (10):1373-1379.