Incorporating Patient Concerns into Discharge Plans: Evaluation of a Patient-Generated Checklist

Abstract

Background: This paper reports on the effectiveness of a checklist that assists patients to transition safely and sustainably from hospital to home. Methods: Medical wards in three tertiary public hospitals in metropolitan Adelaide provided subjects during 2004. Eligible patients were English-literate and aged at least 60 years, provided written informed consent and had an unplanned hospital admission for a new medical condition. Data was excluded post-hoc if subjects had another hospital readmission for the same condition within seven days of discharge. The study had a quasi-experimental study design in which each hospital acted as its own control. In each hospital, the first half of the study period measured the outcome of usual discharge planning practices (control phase), and the second half of the study period measured the outcome following administration of the checklist (intervention). Quantitative and qualitative (grounded theory) evaluation methods were used. Results: 464 potentially eligible patients were approached and 317 (63.3%) consented to participate (210 control and 107 intervention subjects). Post-hoc exclusion and loss to follow-up reflected 60% (control) and 42% (intervention) subjects. Unplanned readmission to hospital (post hoc exclusion) reflected 21% control and 39% intervention phase subjects. A key reason for loss to follow-up was inability to contact subjects seven days after discharge (29% control, 16% intervention phases). Complete outcome data was collected from 148 subjects. For patients with family/ friends who visited them in hospital, the checklist provided the opportunity for joint discussion and decision-making prior to discharge about daily living activities. These activities were often additional to formal discharge plans. The short duration of hospital admission, and generally poor health precluded many patients without family/ friends from obtaining maximum benefit from the checklist. Conclusion: The checklist improved patients’ preparedness for discharge, particularly when family/ friends were involved.

Interventions for the empowerment of older people and informal caregivers in transitional care decision-making: short report of a systematic review

“…Hospital discharge preparation tools were operationalized as planning manuals and checklists that encourage people to consider all aspects of hospital discharge, necessary arrangements, and their personal discharge readiness. The two studies evaluating such tools as a single intervention showed peoples’ appreciation for the tools with a view to their relevance and utility, but indicated no effects on the quality of discharge [ 22 , 27 ].…”

“…• No difference in ED-readmissions between the intervention group and control at 30 and 180 days (11.0% vs 14.2%; OR = 0.76; 95% CI 0.44–1.30; and 37.1% vs 36.0%; OR = 1.16; 95% CI 0.78–1.72 respectively). Grimmer, 2006, Australia [ 22 ] Hospital discharge preparation tool Before-after study Older people facing hospital discharge Intv n = 107 (mean = 70) Contr n = 210 (mean = 69) Primary: Quality of preparation for discharged (self-assessed). Secondary: Experiences with managing at home, if hospital could have done more, and use of the tool.…”

Feasibility of implementing a surgical patient safety checklist: prospective cross-sectional evaluation

“…Hardiman and colleagues developed a patient checklist for postsurgical care for patients who had undergone ileostomy surgery [6]. Other patient checklists have been developed to aid discharge from hospital following medical admissions and one preoperative visit checklist aiming to increase parents' understanding of the surgical consent process for paediatric orthopaedic patients [7,8]. These studies suggest that patient checklists and similar interventions are feasible to use [6][7][8].…”

“…Other patient checklists have been developed to aid discharge from hospital following medical admissions and one preoperative visit checklist aiming to increase parents' understanding of the surgical consent process for paediatric orthopaedic patients [7,8]. These studies suggest that patient checklists and similar interventions are feasible to use [6][7][8]. To our knowledge, only two studies to date have investigated patient-completed checklists' feasibility and effectiveness.…”