Implementing Patient-Oriented Discharge Summaries (PODS): A Multi-site Pilot Across Early Adopter Hospitals

Hahn‐Goldberg, Shoshana; Okrainec, Karen; Damba, Cynthia; Huynh, Tai; Lau, Davina; Maxwell, Joanne; McGuire, Ryan M.; Yang, Lily; Abrams, Howard

doi:10.12927/hcq.2016.24610

Cited by 36 publications

(44 citation statements)

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“…We developed 2 sets of standardized semistructured openended interview guides, 1 for patients and 1 for family caregivers, to collect data based on a literature review and a pilot study 14 (Appendix 1, available at www.cmajopen.ca/content /7/3/ E478/suppl/DC1). Questions aimed to explore what factors affect the understanding and use of instructions.…”

Section: Data Collectionmentioning

confidence: 99%

Patients’ and caregivers’ perspectives on factors that influence understanding of and adherence to hospital discharge instructions: a qualitative study

Okrainec

Hahn‐Goldberg

Abrams

et al. 2019

cmajo

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Background: Many patients have difficulty understanding and adhering to discharge instructions once home from hospital. We assessed patient and family caregiver perspectives on factors that influence understanding of and adherence to discharge instructions. Methods: We conducted a qualitative study using semistructured interviews of participants aged 18 years or more enrolled in a multicentre mixed-methods study who were discharged from 3 acute care hospitals across Ontario with a diagnosis of congestive heart failure, chronic obstructive pulmonary disease or pneumonia. Patients were recruited between March and November 2016. We used directed content analysis to derive themes and subthemes. Results: Twenty-seven participants (16 patients and 11 family members) described 5 themes that affected their understanding of and adherence to discharge instructions: 1) the role of caregivers, 2) relationships with inpatient and outpatient health care providers, 3) previous hospital stay, 4) barriers to accessing postdischarge care and 5) system-level processes. Subthemes highlighted the importance participants attributed to who provides the instructions, the development of resilience and advocacy through previous admissions, the benefits of addressing language and physical disability barriers, reviewing instructions in a unhurried manner, and ensuring that written instructions are meaningful and actionable. Interpretation: Care transition interventions targeting improved communication are unlikely to improve understanding of and adherence to discharge instructions on their own. A patient-centred framework that promotes positive relationships with a patient's circle of care, reflects previous experiences with discharge, addresses equity barriers, and enhances strategies for patient and caregiver engagement at the time of discharge may optimize understanding and adherence once the patient is home.

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Section: Data Collectionmentioning

confidence: 99%

Patients’ and caregivers’ perspectives on factors that influence understanding of and adherence to hospital discharge instructions: a qualitative study

Okrainec

Hahn‐Goldberg

Abrams

et al. 2019

cmajo

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“…In addition, it can increase the likelihood of adverse events, often related to incorrect adherence to medication, to repeat ED visits, and lack of follow-up on pending test results (Bazarian, Hartman, & Delahunta, 2000;Butler & Cooper, 2004;Clarke et al, 2005;Engel et al, 2009;Foran, Wuerth-Sarvis, & Milne, 2010;Grover, Berkowitz, & Lewis, 1994;Han, Barnard, & Chapman, 2009;Hastings et al, 2011;Lerman & Kobernick, 1987). Systematic literature reviews suggest a number of interventions to improve discharge communication (Samuels-Kalow et al, 2012;Watson & McKinstry, 2009), such as using graphic aids (Houts et al, 1998;Wolf et al, 2011;Zeng-Treitler, Kim, & Hunter, 2008), checking for comprehension (Fink et al, 2010;Schillinger et al, 2003;White, Mason, Feehan, & Templeton, 1995), assistance with follow-up appointments (Racine, Alderman, & Avner, 2009;Vinson & Patel, 2009;Zorc, Chew, Allen, & Shaw, 2009), standardizing the information (Considine & Brennan, 2007;Graumlich, Novotny, Nace, & Aldag, 2009;Isaacman, Purvis, Gyuro, Anderson, & Smith, 1992;Rogers et al, 2007), as well as combined approaches such as the PODS tool (Hahn-Goldberg et al, 2016). One way to standardize communication is to provide written information (Johnson & Sandford, 2005); however, this can be difficult and time-consuming, in particular if information is not to be generic but tailored to the needs of a specific patient, and if patient literacy is low, or the diagnosis is (yet) unclear.…”

Section: The Importance Of Discharge Informationmentioning

confidence: 99%

Information structuring improves recall of emergency discharge information: a randomized clinical trial

Ackermann

Ghanim

Heierle

et al. 2016

Psychology, Health & Medicine

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This article examines the extent to which structuring Emergency Department discharge information improves the ability to recall that information, and whether such benefits interact with relevant prior knowledge. Using three samples of students with different levels of prior medical knowledge, we investigated the amount of information recalled after structured vs. non-structured presentation of information. Across all student samples, the structured discharge information led to a relative increase in recalled items of 17% compared to non-structured discharge information (M = 9.70, SD = 4.96 vs. M = 8.31, SD = 4.93). In the sample with least medical knowledge, however, the structured discharge information resulted in a relative increase in recall by 42% (M = 8.12 vs. M = 5.71). These results suggest that structuring discharge information can be a useful tool to improve recall of information and is likely to be most beneficial for patient populations with lower levels of medical knowledge.

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“…For example, hospitals can do better at involving patients in the discharge process and providing a number to call. Indeed, participants in our study noted some examples of this being done well already and researchers in our jurisdiction have developed a patient-oriented discharge process currently under evaluation 47. Many patients described difficulties getting timely follow-up with their family physician but other described their doctor calling them proactively post-discharge to book an appointment—a quality improvement focus for many primary care practices in Ontario 48…”

Section: Discussionmentioning

confidence: 72%

Patient and caregiver priorities in the transition from hospital to home: results from province-wide group concept mapping

et al. 2020

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BackgroundPatients and caregivers often face significant challenges when they are discharged home from hospital. We sought to understand what influenced patient and caregiver experience in the transition from hospital to home and which of these aspects they prioritised for health system improvement.MethodsWe conducted group concept mapping over 11 months with patients—and their caregivers—who were admitted to a hospital overnight in the last 3 years in Ontario, Canada and discharged home. Home included supportive housing, shelters and long-term care. Participants responded to a single focal prompt about what affected their experience during the transition. We summarised responses in unique statements. We then recruited participants to rate each statement on a five-point scale on whether addressing this gap should be a priority for the health system. The provincial quality agency recruited participants in partnership with patient, community and healthcare organisations. Participation was online, in-person or virtual.Results736 participants provided 2704 responses to the focal prompt. Unique concepts were summarised in 52 statements that were then rated by 271 participants. Participants rated the following three statements most highly as a gap that should be a priority for the health system to address (in rank order): ‘Not enough publicly funded home care services to meet the need’, ‘Home care support is not in place when arriving home from hospital’ and ‘Having to advocate to get enough home care’. The top priority was consistent across multiple subgroups.ConclusionsIn a country with universal health insurance, patients and caregivers from diverse backgrounds consistently prioritised insufficient public coverage for home care services as a gap the health system should address to improve the transition from hospital to home.

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Implementing Patient-Oriented Discharge Summaries (PODS): A Multi-site Pilot Across Early Adopter Hospitals

Cited by 36 publications

References 0 publications

Patients’ and caregivers’ perspectives on factors that influence understanding of and adherence to hospital discharge instructions: a qualitative study

Patients’ and caregivers’ perspectives on factors that influence understanding of and adherence to hospital discharge instructions: a qualitative study

Information structuring improves recall of emergency discharge information: a randomized clinical trial

Patient and caregiver priorities in the transition from hospital to home: results from province-wide group concept mapping

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