Understanding the patient experience of early unplanned hospital readmission following acute care discharge: a qualitative descriptive study

Abstract

ObjectivesTo understand from a patient and carer perspective: (1) what features of the discharge process could be improved to avoid early unplanned hospital readmission (within 72 hours of acute care discharge) and (2) what elements of discharge planning could have enhanced the discharge experience.DesignA qualitative descriptive design was used. Study data were collected using semi-structured interviews that were transcribed verbatim and analysed using inductive thematic analysis. Data related to participant characteristic were collected by medical record audit and summarised using descriptive statistics.SettingThree acute care hospitals from one health service in Australia.ParticipantsPatients who had an early unplanned hospital readmission and/or their carers, if present during the interviews and willing to participate, with patient permission.FindingsThirty interviews were conducted (23 patients only; 6 patient and carer dyads; 1 carer only). Five themes were constructed: ‘experiences of care’, ‘hearing and being heard’, ‘what’s wrong with me’, ‘not just about me’ and ‘all about going home’. There was considerable variability in patients’ and carers’ experiences of hospital care, discharge processes and early unplanned hospital readmission. Features of the discharge process that could be improved to potentially avoid early unplanned hospital readmission were better communication, optimal clinical care including ensuring readiness for discharge and shared decision-making regarding discharge timing and goals on returning home. The discharge experience could have been enhanced by improved communication between patients (and carers) and the healthcare team, not rushing the discharge process and a more coordinated approach to patient transport home from hospital.ConclusionsThe study findings highlight the complexities of the discharge process and the importance of effective communication, shared decision-making and carer engagement in optimising hospital discharge and reducing early unplanned hospital readmissions.

Exploring orthopaedic patients’ experiences of hospital discharge: Implications for nursing care

“…Despite positive feedback about the discharge information, some participants commented on limitations of the discharge instructions, specifically those related to medication for pain management, constipation, and wound care, all of which are important areas for orthopaedic surgical patients to understand in order to optimise their recovery. This concurrs with other studies where patients have identified the need for improvements to discharge education ( Considine et al, 2020 ;Harrison, Walton, & Manias, 2015 ;Nurhayati, Songwathana, & Vachprasit, 2018 ).…”

Influencing factors and their relationships of risk perception and decision-making behaviour of polypharmacy in patients with chronic diseases: a qualitative descriptive study

“…29 The data collection framework involved semi-structured interviews that elicit information, whereas also enable patients and physicians to elaborate on their comprehension of polypharmacy at the same time. 30 After refining the influencing factors, we integrated them into an appropriate quantity to construct the interpretative structural model of the medication decision-making behaviour in patients with chronic diseases. The main idea of the interpretative structural modelling method is to decompose a complex system into several subsystems according to experts' knowledge and practical experience, and to construct a multilevel hierarchical structure model, 31 which helps to clarify the interaction among system elements.…”

What makes a “successful” or “unsuccessful” discharge letter? Hospital clinician and General Practitioner assessments of the quality of discharge letters

“…International evidence suggests that discharge letters are unsatisfactory for a number of reasons including: incomplete and insufficient information [11][12][13], unclear follow up plans [12,14,15], letter inaccuracies [16], delayed letter delivery [12,17,18], inadequate medication information [19,20], lack of patient-centredness (e.g. letter dense with jargon) [12,21,22] and general communication gaps leading to adverse events such as patient readmissions [23,24].…”