Implementation, spread and impact of the Patient Oriented Discharge Summary (PODS) across Ontario hospitals: a mixed methods evaluation

Abstract

Background Traditional discharge processes lack a patient-centred focus. This project studied the implementation and effectiveness of an individualized discharge tool across Ontario hospitals. The Patient Oriented Discharge Summary (PODS) is an individualized discharge tool with guidelines that was co-designed with patients and families to enable a patient-centred process. Methods Twenty one acute-care and rehabilitation hospitals in Ontario, Canada engaged in a community of practice and worked over a period of 18 months to implement PODS. An effectiveness-implementation hybrid design using a triangulation approach was used with hospital-collected data, patient and provider surveys, and interviews of project teams. Key outcomes included: penetration and fidelity of the intervention, change in patient-centred processes, patient and provider satisfaction and experience, and healthcare utilization. Statistical methods included linear mixed effects models and generalized estimating equations. Results Of 65,221 discharges across hospitals, 41,884 patients (64%) received a PODS. There was variation in reach and implementation pattern between sites, though none of the between site covariates was significantly associated with implementation success. Both high participation in the community of practice and high fidelity were associated with higher penetration. PODS improved family involvement during discharge teaching (7% increase, p = 0.026), use of teach-back (11% increase, p < 0.001) and discussion of help needed (6% increase, p = 0.041). Although unscheduled healthcare utilization decreased with PODS implementation, it was not statistically significant. Conclusions This project highlighted the system-wide adaptability and ease of implementing PODS across multiple patient groups and hospital settings. PODS demonstrated an improvement in patient-centred discharge processes linked to quality standards and health outcomes. A community of practice and high quality content may be needed for successful implementation.

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

“…In developing the PODS-ICU tool, we relied on the pre-existing OpenLab PODS tool and input from patient-partners to ensure the tool addressed specific informational needs of patients in the ICU ( e.g. , summary of ICU events, medications, upcoming tests and appointments, what to expect during recovery, resources for help)[ 21 , 27 , 45 ]. This allowed the PODS-ICU to support reliable delivery of essential information from clinicians to patients and family-caregivers at discharge from the ICU, whether the patient was being transferred to a ward in the hospital or directly home.…”

“…, when to seek care, pain management), and medications from healthcare providers to patients and their families[ 46 - 57 ]. Similarly to the PODS-ICU, many discharge communications from various acute care settings have been reported as time consuming and adding to healthcare provider workload[ 40 , 45 , 57 , 58 ]. However, they have also been reported to reduce hospital readmissions, improve treatment adherence, and enhance patient satisfaction and can be considered important to successful transitions in care[ 40 , 57 , 58 ].…”

“…We recognize that ICU populations differ in type and severity of illness and some ICU staff may have more capacity to implement the PODS-ICU. As the OpenLab’s PODS has shown the potential to improve patient outcomes in various care settings[ 21 , 45 ], the PODS-ICU may be more successful in settings where it is better integrated into clinician work flow[ 45 ].…”

Medication Supports at Transitions Between Hospital and Other Care Settings: A Rapid Scoping Review

“… 92 Members of our research team have successfully used these approaches to engage patients, caregivers, and health-care providers in co-developing patient-oriented discharge instructions, which has subsequently undergone wide-scale implementation and evaluation at the provincial level with positive results. 90 , 93 The application of these approaches when developing medication-focused interventions at care transitions is an important opportunity for researchers to explore.…”

Raising the bar for patient experience during care transitions in Canada: A repeated cross-sectional survey evaluating a patient-oriented discharge summary at Ontario hospitals

“…Patients randomized to receive a tailored discharge care plan along with one-on-one discussions with a health care provider on symptom recognition, medication reconciliation, and strategies for navigating the health system along with care coordination when needed were not found to have improved patient experience [26]. It is also possible that the impact of these care interventions lays more in the fidelity of the tool however –such as a higher engagement of caregivers or use of teach-back [13]. This may help explain why patients discharged from hospitals implementing PODS had a higher odds of having discussed the help they would need once leaving hospital, given patients may rely on caregivers for tasks beyond what public home care provides.…”