&lt;p&gt;Engaging patients and informal caregivers to improve safety and facilitate person- and family-centered care during transitions from hospital to home &amp;ndash; a qualitative descriptive study&lt;/p&gt;

Backman, Chantal; Cho-Young, Danielle

doi:10.2147/ppa.s201054

Cited by 31 publications

(34 citation statements)

References 27 publications

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“…Studies have documented the complex but indispensable role informal caregivers play in care coordination and highlight how family presence when reviewing discharge instructions can help reinforce, clarify and improve adherence. 19,20 The importance that perceived relationships with health care providers may play in the patient's level of engagement and adherence to instructions has previously been described as important for adherence to medications. 21 This factor is of timely importance given recent work showing that both inpatient and outpatient physicians rarely feel responsible for patient care and adherence after discharge.…”

Section: Discussionmentioning

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: Discussionmentioning

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

View full text Add to dashboard Cite

show abstract

“…Poor communication in the health-care system, generally (not just during care transitions), is a common problem expressed by many patients and their caregivers, 41 typically those who have multiple chronic conditions, 42 require significant health care and interact with various care providers across settings. 43 Care transitions, in particular, are a heightened time of vulnerability for patients and their caregivers. 44 In our research, we found that poor communication was par- is too long, patient and caregivers can become confused and frustrated.…”

Section: Communicating Uncertaintymentioning

confidence: 99%

An alternate level of care plan: Co‐designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges

Kuluski

Cadel

et al. 2020

Health Expectations

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Objective To engage with patients, caregivers and care providers to co‐design components of an intervention that aims to improve delayed hospital discharge experiences. Design This is a qualitative study, which entailed working groups and co‐design sessions utilizing World Café and deliberative dialogue techniques to continually refine the intervention. Setting and Participants Our team engaged with 61 participants (patients, caregivers and care providers) in urban and rural communities across Ontario, Canada. A 7‐member Patient and Caregiver Advisory Council participated in all stages of the research. Results Key challenges experienced during a delayed discharge by patients, caregivers and care providers were poor communication and a lack of care services. Participants recommended a communication guide to support on‐going conversation between care providers, patients and caregivers. The guide included key topics to cover and questions to ask during initial and on‐going conversations to manage expectations and better understand the priorities and goals of patients and caregivers. Service recommendations included getting out of bed and dressed each day, addressing the psycho‐social needs of patients through tailored activities and having a storyboard at the bedside to facilitate on‐going engagement. Discussion and Conclusions Our findings outline ways to meaningfully engage patients and caregivers during a delayed hospital discharge. Combining this with a minimal basket of services can potentially facilitate a better care experience and outcomes for patients, their care providers and families.

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“…Australia and the United Kingdom have developed national standards for electronic DSs [ 18 , 28 ], and Canadian researchers have explored standardizing DSs in Nova Scotia [ 29 ]. In contrast, most US research aimed at increasing patient safety during care transitions focuses upon improving discharge planning processes (eg, training clinicians to generate more useful discharge documentation [ 30 , 31 ] or involving patients and caregivers in discharge planning [ 31 , 32 ]).…”

Section: Discussionmentioning

confidence: 99%

Usability of Electronic Health Record–Generated Discharge Summaries: Heuristic Evaluation

Tremoulet¹,

Shah²,

Acosta³

et al. 2021

J Med Internet Res

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Background Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. Objective This study aimed to (1) identify the information about elderly patients’ recent acute care visits needed to coordinate their care, (2) use this information to assess discharge summaries, and (3) provide recommendations to help improve the quality of electronic health record (EHR)–generated discharge summaries, thereby increasing patient safety. Methods A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently discharged elderly patients. Based upon those data, 2 guidelines for creating useful discharge summaries were created. The new guidelines, along with 17 previously developed medical documentation usability heuristics, were applied to assess 4 simulated elderly patient discharge summaries. Results The initial research effort yielded a list of 29 items that should always be included in elderly patient discharge summaries and a list of 7 “helpful, but not always necessary” items. Evaluation of 4 deidentified elderly patient discharge summaries revealed that none of the documents contained all 36 necessary items; between 14 and 18 were missing. The documents each had several other issues, and they differed significantly in organization, layout, and formatting. Conclusions Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care transition–related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization.

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<p>Engaging patients and informal caregivers to improve safety and facilitate person- and family-centered care during transitions from hospital to home – a qualitative descriptive study</p>

Cited by 31 publications

References 27 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

An alternate level of care plan: Co‐designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges

Usability of Electronic Health Record–Generated Discharge Summaries: Heuristic Evaluation

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