Journal Article
Harvey Newnham,
1
Department of Medicine
,
Monash University
,
Level 5, 99 Commercial Road, Melbourne, Victoria
3004,
Australia
2
General Medicine, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004
,
Australia
Search for other works by this author on:
Anna Barker,3
School of Public Health and Preventive Medicine
,
Monash University
,
Level 4, 553 St. Kilda Road, Melbourne, Victoria
3004,
Australia
Search for other works by this author on:
Edward Ritchie,2
General Medicine, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004
,
Australia
Search for other works by this author on:
Karen Hitchcock,2
General Medicine, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004
,
Australia
Search for other works by this author on:
Harry Gibbs,1
Department of Medicine
,
Monash University
,
Level 5, 99 Commercial Road, Melbourne, Victoria
3004,
Australia
2
General Medicine, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004
,
Australia
Search for other works by this author on:
Sara Holton3
School of Public Health and Preventive Medicine
,
Monash University
,
Level 4, 553 St. Kilda Road, Melbourne, Victoria
3004,
Australia
1Address reprint requests to: Sara Holton, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, Victoria 3004, Australia. Tel: +61-3-9903-0294; Email:
Search for other works by this author on:
Received:
20 December 2016
Revision received:
13 August 2017
Published:
07 September 2017
- Split View
-
- Article contents
- Figures & tables
- Video
- Audio
- Supplementary Data
Cite
Cite
Harvey Newnham, Anna Barker, Edward Ritchie, Karen Hitchcock, Harry Gibbs, Sara Holton, Discharge communication practices and healthcare provider and patient preferences, satisfaction and comprehension: A systematic review, International Journal for Quality in Health Care, Volume 29, Issue 6, October 2017, Pages 752–768, //doi.org/10.1093/intqhc/mzx121
Close
-
- More
Close
Navbar Search Filter Microsite Search Term Search
Abstract
Purpose
To systematically review the available evidence about hospital discharge communication practices and identify which practices were preferred by patients and healthcare providers, improved patient and provider satisfaction, and increased patients’ understanding of their medical condition.
Data sources
OVID Medline, Web of Science, ProQuest, PubMed and CINAHL plus.
Study selection
Databases were searched for peer-reviewed, English-language papers, published to August 2016, of empirical research using quantitative or qualitative methods. Reference lists in the papers meeting inclusion criteria were searched to identify further papers.
Data extraction
Of the 3489 articles identified, 30 met inclusion criteria and were reviewed.
Results of data synthesis
Much research to date has focused on the use of printed material and person-based discharge communication methods including verbal instructions (either in person or via telephone calls). Several studies have examined the use of information technology (IT) such as computer-generated and video-based discharge communication practices. Utilizing technology to deliver discharge information is preferred by healthcare providers and patients, and improves patients’ understanding of their medical condition and discharge instructions.
Conclusion
Well-designed IT solutions may improve communication, coordination and retention of information, and lead to improved outcomes for patients, their families, caregivers and primary healthcare providers as well as expediting the task for hospital staff.
Introduction
Timely and accurate discharge communication is important in continuing patient care between hospitals and primary care physicians (PCP) [1]. The discharge summary is the most common method for documenting and communicating a patient's diagnostic findings, hospital management and planned follow-up to the post-hospital care team [2]. It is a vital communication and information tool which can enhance the quality and continuity of patient care [3, 4]. Effective discharge summaries reduce adverse drug events, unplanned hospital readmission, post-discharge complications and mortality, and increase patient and carer satisfaction [2, 3, 5–11].
Delivery of discharge instructions is often rushed and patients frequently do not understand aspects of their discharge, particularly medication management [12, 13]. Patients who have poor comprehension of discharge instructions may have higher rates of emergency department (ED) visits, hospital readmissions [14] and medication errors [15]. They also lack knowledge about their diagnosis, follow-up care and treatment [16, 17]. Improving patients’ understanding is likely to improve health outcomes and avoid unnecessary healthcare utilization and costs [18, 19].
Despite their importance, discharge summaries are often poorly constructed, incomplete, delayed, misdirected or unhelpful for the healthcare providers in the community [5, 6, 8, 20, 21]. Although they are one of the most commonly produced hospital documents, there is not a standardized process for providing discharge information [22], and little is known about healthcare providers’ and patients’ needs, preferences and satisfaction with processes.
The aim of this review was to identify evidence for the provision of information on transfer of a patient's care from hospital to the community. We sought to review methods used to provide appropriate, contextually sensitive and comprehensible information to a patient, their family, carer and healthcare providers; and to understand which discharge communication practices were: preferred by patients and healthcare providers, improved satisfaction and increased patients’ understanding of their medical condition and treatment.
Method
We followed the PRISMA ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ procedure [23] of identification, screening, eligibility and material included in the review.
Search strategy
Searches were performed for papers published to August 2016 in relevant social science and medical science databases (OVID Medline, Web of Science, ProQuest, PubMed and CINAHL plus). Reference lists in the papers meeting inclusion criteria were also searched to identify further papers.
Inclusion criteria
Papers were included if they described empirical research and were written in English. Papers were excluded if they were conducted in ‘low’ or ‘lower middle’ income countries given the differences in availability, affordability, and accessibility of health services between ‘higher’ and ‘lower’ income countries [24].
Search terms
The search strategy included the medical subject heading terms and multiple synonyms and related keywords listed in Table 1.
1. | ‘Patient discharge’ | OR patient discharge summary* OR pre-discharge OR discharge OR handover OR summary OR information OR plan* OR instructions OR communication OR transfer |
2. | ‘Patient care team’ | |
3. | Hospital to home OR transitions from ward to home OR care transition OR transitional care | |
4. | ‘Patients’ | patient |
5. | ‘Physicians’ | OR healthcare provider |
6. | ‘Medical informatics’ OR ‘video recording’ | OR video OR audio-visual OR video recording OR USB OR DVD OR teleconferencing OR picture OR image OR internet OR letter OR electronic mail OR intervention |
7. | ‘Hospitals’ | OR hospital OR ward OR PCP OR bedside rounding OR ED |
8. | ‘Comprehension’ | OR understanding |
9. | ‘Patient satisfaction’ | OR satisfaction |
1. | ‘Patient discharge’ | OR patient discharge summary* OR pre-discharge OR discharge OR handover OR summary OR information OR plan* OR instructions OR communication OR transfer |
2. | ‘Patient care team’ | |
3. | Hospital to home OR transitions from ward to home OR care transition OR transitional care | |
4. | ‘Patients’ | patient |
5. | ‘Physicians’ | OR healthcare provider |
6. | ‘Medical informatics’ OR ‘video recording’ | OR video OR audio-visual OR video recording OR USB OR DVD OR teleconferencing OR picture OR image OR internet OR letter OR electronic mail OR intervention |
7. | ‘Hospitals’ | OR hospital OR ward OR PCP OR bedside rounding OR ED |
8. | ‘Comprehension’ | OR understanding |
9. | ‘Patient satisfaction’ | OR satisfaction |
Combined terms: 1 AND 2 AND 3 AND 4 AND 5 AND 6 AND 7 AND 8 AND 9.
1. | ‘Patient discharge’ | OR patient discharge summary* OR pre-discharge OR discharge OR handover OR summary OR information OR plan* OR instructions OR communication OR transfer |
2. | ‘Patient care team’ | |
3. | Hospital to home OR transitions from ward to home OR care transition OR transitional care | |
4. | ‘Patients’ | patient |
5. | ‘Physicians’ | OR healthcare provider |
6. | ‘Medical informatics’ OR ‘video recording’ | OR video OR audio-visual OR video recording OR USB OR DVD OR teleconferencing OR picture OR image OR internet OR letter OR electronic mail OR intervention |
7. | ‘Hospitals’ | OR hospital OR ward OR PCP OR bedside rounding OR ED |
8. | ‘Comprehension’ | OR understanding |
9. | ‘Patient satisfaction’ | OR satisfaction |
1. | ‘Patient discharge’ | OR patient discharge summary* OR pre-discharge OR discharge OR handover OR summary OR information OR plan* OR instructions OR communication OR transfer |
2. | ‘Patient care team’ | |
3. | Hospital to home OR transitions from ward to home OR care transition OR transitional care | |
4. | ‘Patients’ | patient |
5. | ‘Physicians’ | OR healthcare provider |
6. | ‘Medical informatics’ OR ‘video recording’ | OR video OR audio-visual OR video recording OR USB OR DVD OR teleconferencing OR picture OR image OR internet OR letter OR electronic mail OR intervention |
7. | ‘Hospitals’ | OR hospital OR ward OR PCP OR bedside rounding OR ED |
8. | ‘Comprehension’ | OR understanding |
9. | ‘Patient satisfaction’ | OR satisfaction |
Combined terms: 1 AND 2 AND 3 AND 4 AND 5 AND 6 AND 7 AND 8 AND 9.
SH conducted the initial search; all authors together made final decisions about inclusion.
Selection of articles
The selection process is outlined in Fig. 1.
Figure 1
PRISMA flow diagram of review process.
Quality assessment
The methodological quality of each study was assessed by two authors (H.N. and S.H.) independently using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (QualSyst tool) [25]. This tool was used as it is designed to appraise both qualitative and quantitative papers, using two scoring systems. The quantitative checklist included 14 criteria and qualitative checklist 10. Each criterion is scored as ‘yes’ (2), ‘partial’ (1) or ‘no’ (0). A summary score was calculated for each paper to produce an overall quality rating. For the quantitative studies, there is also the possibility to score ‘not applicable’, such items were excluded from the calculation of the summary score. The maximum total score for the quantitative studies is 28 and 20 for the qualitative studies (Table 1). Studies were excluded based on a minimum threshold of a summary score of 0.55 [25].
Data analysis
The review included papers reporting studies using qualitative or quantitative methods. We therefore undertook an aggregative synthesis in which the data were summarized with a narrative review of the evidence [26]. Quantitative synthesis (meta-analysis) was deemed not appropriate due to the variability in research design, populations, types of interventions, and outcomes of the studies identified.
The full text of included papers was reviewed by two authors (H.N. and S.H.) for: (i) all discharge communication practices used to provide information to a patient, their family and carer and their healthcare providers; and (ii) measures of patient and healthcare provider satisfaction and preferences, and patient comprehension. Reported practices were categorized into groups according to their format. All authors discussed and agreed on the final categories. For each paper, we identified and tabulated the year published, research aims, sample characteristics, methods, outcomes/measures and relevant findings.
We compared the effectiveness of the identified methods in terms of healthcare provider and patient preferences and satisfaction; and patient comprehension and knowledge.
Results
We included in the review 30 papers reporting 30 studies which described practices for transferring information about a patient's care from hospital to the community. Studies were conducted in 10 countries: and used quantitative (23 papers—13 randomized control studies, 7 surveys, 2 pre–post design, 1 record audit) or qualitative methods (2 papers: 1 in-depth interviews, 1 focus group). Five studies employed mixed-methods.
Analysis of the 30 papers revealed 3 methods used to provide discharge information: 1. Information technology (IT)-based methods (15 papers); 2. Person-based methods (13 papers); and 3. Written methods (11 papers). Multiple methods were identified in 9 papers [4, 10, 28, 29, 33, 38, 39, 47, 48].
These practices were evaluated in terms of the identified measures: healthcare provider and patient preferences (5 papers) and satisfaction (23 papers); and patient comprehension and knowledge (13 papers).
Overall the studies were of good quality with a summary score of 0.83 or higher indicating appropriate study design and research questions, definition of outcomes and exposures, reporting of bias and confounding, and sufficient reporting of results and limitations (Table 2a, 2b). No studies were excluded based on quality scores.
Table 2a
Assessment of Study Quality using the QualSyst tool [25]—Quantitative Studies
Archbold et al. [27] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 1 | 0 | N/A | 2 | 2 | 17/20 = 0.85 |
Atzema et al. [50] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 28/28 = 1.00 |
Bloch and Bloch [17] | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 25/26 = 0.96 |
Branger et al. [38] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 0 | N/A | N/A | 2 | 2 | 16/18 = 0.89 |
Braun et al. [42] | 2 | 1 | 2 | 2 | 2 | N/A | N/A | 2 | 1 | 2 | 1 | 1 | 2 | 2 | 20/24 = 0.83 |
Cawthon et al. [36] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Choi et al. [37] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 22/22 = 1.00 |
D’Amore et al. [43] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Dedhia et al. [7] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 20/20 = 1.00 |
Graumlich et al. [28] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 22/22 = 1.00 |
Grimmer & Moss [44] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Heng et al. [47] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Heyworth [30] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Hickey et al. [41] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Horwitz et al. [45] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Lin et al. [49] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Lindpaintner et al. [34] | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 26/26 = 1.00 |
Maslove et al. [33] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 24/24 = 1.00 |
Mueller et al. [51] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Mutsch and Herbert [10] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Naylor et al. [31] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Naylor et al. [32] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Newnham et al. [35] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 1 | N/A | 2 | 2 | 19/20 = 0.95 |
O’Leary et al. [39] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 20/20 = 1.00 |
O’Leary et al. [46] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 1 | N/A | 2 | 2 | 19/20 = 0.95 |
Preen et al. [4] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 22/22 = 1.00 |
Spandorfer et al. [48] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
van Walraven et al. [29] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 22/22 = 1.00 |
Archbold et al. [27] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 1 | 0 | N/A | 2 | 2 | 17/20 = 0.85 |
Atzema et al. [50] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 28/28 = 1.00 |
Bloch and Bloch [17] | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 25/26 = 0.96 |
Branger et al. [38] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 0 | N/A | N/A | 2 | 2 | 16/18 = 0.89 |
Braun et al. [42] | 2 | 1 | 2 | 2 | 2 | N/A | N/A | 2 | 1 | 2 | 1 | 1 | 2 | 2 | 20/24 = 0.83 |
Cawthon et al. [36] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Choi et al. [37] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 22/22 = 1.00 |
D’Amore et al. [43] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Dedhia et al. [7] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 20/20 = 1.00 |
Graumlich et al. [28] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 22/22 = 1.00 |
Grimmer & Moss [44] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Heng et al. [47] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Heyworth [30] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Hickey et al. [41] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Horwitz et al. [45] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Lin et al. [49] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Lindpaintner et al. [34] | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 26/26 = 1.00 |
Maslove et al. [33] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 24/24 = 1.00 |
Mueller et al. [51] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Mutsch and Herbert [10] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Naylor et al. [31] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Naylor et al. [32] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Newnham et al. [35] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 1 | N/A | 2 | 2 | 19/20 = 0.95 |
O’Leary et al. [39] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 20/20 = 1.00 |
O’Leary et al. [46] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 1 | N/A | 2 | 2 | 19/20 = 0.95 |
Preen et al. [4] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 22/22 = 1.00 |
Spandorfer et al. [48] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
van Walraven et al. [29] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 22/22 = 1.00 |
2 = yes; 1 = partial; 0 = no; N/A = not applicable.
Table 2a
Assessment of Study Quality using the QualSyst tool [25]—Quantitative Studies
Archbold et al. [27] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 1 | 0 | N/A | 2 | 2 | 17/20 = 0.85 |
Atzema et al. [50] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 28/28 = 1.00 |
Bloch and Bloch [17] | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 25/26 = 0.96 |
Branger et al. [38] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 0 | N/A | N/A | 2 | 2 | 16/18 = 0.89 |
Braun et al. [42] | 2 | 1 | 2 | 2 | 2 | N/A | N/A | 2 | 1 | 2 | 1 | 1 | 2 | 2 | 20/24 = 0.83 |
Cawthon et al. [36] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Choi et al. [37] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 22/22 = 1.00 |
D’Amore et al. [43] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Dedhia et al. [7] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 20/20 = 1.00 |
Graumlich et al. [28] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 22/22 = 1.00 |
Grimmer & Moss [44] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Heng et al. [47] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Heyworth [30] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Hickey et al. [41] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Horwitz et al. [45] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Lin et al. [49] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Lindpaintner et al. [34] | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 26/26 = 1.00 |
Maslove et al. [33] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 24/24 = 1.00 |
Mueller et al. [51] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Mutsch and Herbert [10] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Naylor et al. [31] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Naylor et al. [32] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Newnham et al. [35] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 1 | N/A | 2 | 2 | 19/20 = 0.95 |
O’Leary et al. [39] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 20/20 = 1.00 |
O’Leary et al. [46] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 1 | N/A | 2 | 2 | 19/20 = 0.95 |
Preen et al. [4] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 22/22 = 1.00 |
Spandorfer et al. [48] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
van Walraven et al. [29] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 22/22 = 1.00 |
Archbold et al. [27] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 1 | 0 | N/A | 2 | 2 | 17/20 = 0.85 |
Atzema et al. [50] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 28/28 = 1.00 |
Bloch and Bloch [17] | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 25/26 = 0.96 |
Branger et al. [38] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 0 | N/A | N/A | 2 | 2 | 16/18 = 0.89 |
Braun et al. [42] | 2 | 1 | 2 | 2 | 2 | N/A | N/A | 2 | 1 | 2 | 1 | 1 | 2 | 2 | 20/24 = 0.83 |
Cawthon et al. [36] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Choi et al. [37] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 22/22 = 1.00 |
D’Amore et al. [43] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Dedhia et al. [7] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 20/20 = 1.00 |
Graumlich et al. [28] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 22/22 = 1.00 |
Grimmer & Moss [44] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Heng et al. [47] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Heyworth [30] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Hickey et al. [41] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Horwitz et al. [45] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Lin et al. [49] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Lindpaintner et al. [34] | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 26/26 = 1.00 |
Maslove et al. [33] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 24/24 = 1.00 |
Mueller et al. [51] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 18/18 = 1.00 |
Mutsch and Herbert [10] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
Naylor et al. [31] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Naylor et al. [32] | 2 | 2 | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 24/24 = 1.00 |
Newnham et al. [35] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 1 | N/A | 2 | 2 | 19/20 = 0.95 |
O’Leary et al. [39] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 20/20 = 1.00 |
O’Leary et al. [46] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 1 | N/A | 2 | 2 | 19/20 = 0.95 |
Preen et al. [4] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 22/22 = 1.00 |
Spandorfer et al. [48] | 2 | 2 | 2 | 2 | N/A | N/A | N/A | 2 | 2 | 2 | 0 | N/A | 2 | 2 | 18/20 = 0.90 |
van Walraven et al. [29] | 2 | 2 | 2 | 2 | 2 | N/A | N/A | 2 | 2 | 2 | 2 | N/A | 2 | 2 | 22/22 = 1.00 |
2 = yes; 1 = partial; 0 = no; N/A = not applicable.
Table 2b
Assessment of Study Quality using the QualSyst tool [25]—Qualitative Studies
Choi [18] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Hickey et al. [41] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Hofflander et al. [40] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 20/20 = 1.00 |
Mutsch and Herbert [10] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Spandorfer et al. [48] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Choi [18] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Hickey et al. [41] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Hofflander et al. [40] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 20/20 = 1.00 |
Mutsch and Herbert [10] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Spandorfer et al. [48] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
2 = yes; 1 = partial; 0 = no.
Table 2b
Assessment of Study Quality using the QualSyst tool [25]—Qualitative Studies
Choi [18] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Hickey et al. [41] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Hofflander et al. [40] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 20/20 = 1.00 |
Mutsch and Herbert [10] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Spandorfer et al. [48] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Choi [18] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Hickey et al. [41] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Hofflander et al. [40] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 20/20 = 1.00 |
Mutsch and Herbert [10] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
Spandorfer et al. [48] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 19/20 = 0.95 |
2 = yes; 1 = partial; 0 = no.
The study design and methods, sample characteristics and relevant categories of each reviewed paper are presented in Table 3. A summary of the studies and the discharge communication method(s) used and measures evaluated is given in Table 4.
Table 3.
Study characteristics and discharge practices and outcomes identified in papers included in the review
Archbold et al. (1998) [27] UK |
| To determine the preferences of GPs for standard dictated or computer-generated discharge summaries for patients with acute coronary syndromes | Questionnaire | N = 147; GPs | GP preference (study-specific measure) | Majority (68.5%) of GPs preferred the computerized summary and most (66.9%) thought it provided the clearer management plan and 70.8% recommended its use for other specialities |
Atzema et al. (2013) [16] Canada |
| To evaluate the effect of viewing an online video of diagnosis-specific discharge instructions on patient comprehension and recall of instructions | Prospective, single-centre, randomized controlled trial |
|
|
|
Bloch & Bloch (2013) [17] USA |
| To determine if adding video discharge instructions affects caregivers’ understanding of their child's ED visit, plan and follow-up | Randomized controlled trial |
|
| Brief video discharge instructions improved caregiver knowledge both in the ED and 2–5 days after discharge compared with written discharge instructions alone. Caregiver satisfaction with video discharge instructions was also greater than with written discharge instructions |
Branger et al. (1992) [38] The Netherlands |
| To study the effects of the introduction of electronic data interchange between primary and secondary care providers on speed of communication, efficiency of data handling, and satisfaction of general practitioners with communication | Comparison of traditional paper-based communication for laboratory reports and admission-discharge reports between hospital and general practitioners and electronic data interchange |
| GP satisfaction (study-specific measure) | Most GPs (15/ 24) reported that the use of electronic admission-discharge reports provided more accurate and complete information about the care delivered to their patients |
Braun et al. (2009) [42] Israel |
| To investigate whether TFU would increase patient satisfaction, improve compliance and reduce re-hospitalization rate | Randomized control trial | N = 400 | Patient satisfaction (study-specific measure) | Satisfaction was increased in the TFU group compared with control group by 6–12% in most fields. Most TFU patients reported that they performed the tests that were recommended at discharge and received explanations regarding their medications (86.9% (P = 0.02) and 96.7% (P < 0.0001), respectively). 93% of the patients in the TFU group as compared to 84% in the control group reported improvement in their symptoms. A non-significant trend towards fewer readmission was observed in the TFU group (26% vs. 35% P = 0.062) |
Cawthon, et al. 2012 USA |
| To investigate a care transition intervention to reduce medication errors and patients’ assessment of the intervention | Randomized control trial | N = 125 | Patient satisfaction (study-specific measure) |
|
Choi (2013) [18]USA |
| To examine the acceptability and comprehension of pictograph discharge instructions | Focus groups | N = 15; low-literate older adults hip replacement surgery recruited from community hospital | Patient comprehension (study-specific measure) | Participants perceived that the pictograph-based discharge instructions helped them understand the intended healthcare messages, especially for step-by-step procedures of discharge actions |
Choi et al. (2009) [37] Korea | MDIVs 3 = IT based | To evaluate the effectiveness of MDIVs in communicating discharge instructions to patients | Prospective controlled study | N = 161; N = 77 (printed instructions: P group) N = 84 (mobile video instructions: M group) patients with lacerations or sprains in a quaternary emergency centre |
| The mean of the correct answers on wound care in the questionnaire was 2.7 ± 0.7 in the M group and 2.4 ± 0.8 in the P group (P < 0.05). The rate of satisfaction was 90.5% in the M group and 90.9% in the P group (P < 0.05) |
D’Amore et al. (2011) [43] USA |
| To examine patients who received TFU for response differences on a mail satisfaction survey and 30-day readmission rates | Observational study | N = 10 559; patients from a large health system in southeast Texas | Patient satisfaction (study-specific measure) | Completion of a nursing call with a patient who reported a physician appointment was a significant predictor (P < 0.04) of lower 30-day readmissions |
Dedhia et al. (2009) [7] USA |
| To study the feasibility and effectiveness of a discharge planning intervention |
| N = 237; patients ≥65 years admitted to general medicine wards at three hospitals | Patient satisfaction (Activities of Daily Living (38); Care Transition Measure (39)) |
|
Graumlich et al. (2009) [28] USA |
| To measure patient and physician perceptions after discharge with computerized physician order entry software | Cluster randomized controlled trial | N = 631; inpatients discharged to home with high risk for readmission | Patient and physician perceptions (B-PREPARED questionnaire, Modified Physician-PREPARED scale, Satisfaction with Information About Medicines Scale, and study-specific measures) | When comparing patients assigned to discharge software vs. usual care, patient mean (standard deviation [SD]) scores for discharge preparedness were higher (17.7 [4.1] vs. 17.2 [4.0]; coefficient = 0.147; 95% CI = 0.005–0.289; P = 0.042), patient scores for satisfaction with medication information were unchanged (12.3 [4.8] vs. 12.1 [4.6]; coefficient = -0.212; 95% CI = −0.937–0.513; P = 0.567), and their outpatient physicians scored higher quality discharge (17.2 [3.8] vs. 16.5 [3.9]; coefficient = 0.133; 95% CI = 0.015–0.251; P = 0.027). Hospital physicians found mean effort to use discharge software was more difficult than the usual care (6.5 [1.9] vs. 7.9 [2.1]; P = 0.011) |
Grimmer & Moss (2001) [44] Australia |
| To describe the development, validity and application of a new instrument (PREPARED) for obtaining feedback from community consumers of discharge planning activities | Iterative qualitative and quantitative investigations | N = 834; patients aged over 65 years, with a range of conditions, recently discharged from hospital, and their carers | Patient satisfaction (patient and carer versions of PREPARED) | The instrument performed well when compared with interview data, the process and outcome domains were largely independent of each other, as were responses to PREPARED and SF-36 |
Heng et al. (2007) [47] Singapore |
| To evaluate patients’ and caregivers’ compliance to discharge instructions and their ability to recall minor head injury advice |
|
| Patient comprehension/ knowledge (study-specific measure) |
|
Heyworth (2014) [30] USA |
| To pilot an ambulatory medication reconciliation tool |
| N = 60; recently discharged patients from Veteran Affairs Hospital | Patient satisfaction (study-specific measures) | Overall, participants were enthusiastic about SMMRT; 90% said they would use SMMRT again |
Hickey et al. (1996) [41] USA |
| To improve patients’ satisfaction with discharge planning | Mixed-methods study: data from the hospital's Patient Satisfaction Survey, and phone interviews with patients |
| Patient satisfaction (study-specific measures) |
|
Hofflander et al. (2013) [40] Sweden |
| To investigate the experiences of primary healthcare nursing staff regarding discharge planning sessions and to identify their concerns regarding the use of video conferencing in the discharge planning session |
| N = 10; nursing staff from a primary healthcare centre | Healthcare provider preferences (study-specific measure) | Nursing staff in primary healthcare regarded the planning session as stressful, time-consuming and characterized by a lack of respect between nursing staff at the hospital and nursing staff in primary healthcare. They also described uncertainty and hesitation about using video conferences where patients might probably be the losers [patients do not attend video conference] and nursing staff the winners |
Horwitz et al. (2013) [45] USA |
| To conduct a multifaceted evaluation of transitional care from a patient-centred perspective | Prospective observational cohort study |
|
|
|
Lin et al. (2014) [49] Australia |
| To test whether a brief patient-directed discharge letter delivered during a brief discussion prior to discharge would improve patient understanding of their diagnosis and treatment plan | Prospective randomized controlled trial |
| Patient knowledge (study-specific questions) | Participants receiving the letter had an increase to almost full understanding of tests performed (P < 0.001) and to full understanding of post-discharge recommendations. This increase did not persist at 3 or 6 months |
Lindpaintner et al. (2013) [34] Switzerland |
| To test a discharge management intervention using nurse care managers | Single-blind, randomized, controlled interprofessional pilot |
| Healthcare provider and patient satisfaction (study-specific measure) | In the intervention group, satisfaction was higher among patients (P = 0.027) and caregivers (P = 0.008), and PCP rated discharge information higher (P = 0.031) |
Maslove et al. (2009) [33] Canada |
| To assess PCP satisfaction with an electronic discharge summary program as compared to conventional dictated discharge summaries | Cluster randomized trial | N = 209; patient discharges from an academic general medical service |
|
|
Mueller et al. (2015) [51] USA |
| To examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge | Retrospective cohort study | N = 233; patients discharged from a large tertiary care hospital |
| Templated discharge instructions had higher Flesch Reading Ease Level scores (71 vs. 57, P < 0.001) and lower Flesch–Kincaid Grade Level scores (5.6 vs. 7.6, P < 0.001), compared to clinician-generated discharge instructions |
Mutsch & Herbert (2010) [10] USA |
| To determine whether a written educational resource used by nurses at discharge could improve patient knowledge of cardiovascular medications | Cross-sectional, descriptive mixed-method study: pre- and post-intervention, focus groups, Interviews |
| Patient comprehension (study-specific measure) | More patients were able to verbalize correct medication, dose, schedule, and purpose post-intervention than pre-intervention (30% vs. 58%, chi-square = 7.955, df = 1, P-value = 0.005) |
Naylor et al. (2004) [31] USA |
| To examine the effectiveness of a transitional care intervention delivered by APNs to elders hospitalized with heart failure | Randomized, controlled trial |
| Patient satisfaction | For intervention patients, only short-term improvements were demonstrated in patient satisfaction (assessed at 2 and 6 weeks, P < 0.001) |
Naylor et al. (1999) [32] USA |
| To examine the effectiveness of an APN-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions |
|
| Patient satisfaction (study-specific measure) | There were no significant group differences in patient satisfaction |
Newnham et al. (2015) [35] Australia |
| To assess the feasibility and patient acceptance of a personalized interdisciplinary audio-visual record (CareTV) | Descriptive pilot study | N = 20; general medical patients |
|
|
O’Leary et al. (2009) [39] USA |
| To evaluate the effect of a newly-created electronic discharge summary |
|
| Healthcare provider satisfaction (study-specific measure) | Satisfaction with quality and timeliness of discharge summaries improved with the use of the electronic discharge summary (mean quality rating 3.04 versus 3.64; P < 0.001, mean timeliness rating 2.59 vs. 3.34; P < 0.001). A higher percentage of electronic discharge summaries were completed within 3 days of discharge as compared with dictated discharge summaries (44.8% vs. 74.1%; P < 0.001) |
O’Leary et al. (2006) [46] USA |
| To evaluate satisfaction with current discharge summaries, perceptions of preventable adverse events related to suboptimal information transfer, and the perceived need for the electronic discharge summary we plan to design | Physician survey | N = 226 physicians | Healthcare provider satisfaction (study-specific measure) | Only 19% of the participants were satisfied or very satisfied with timeliness, and only 32% were satisfied or very satisfied with the quality of discharge summaries. Overall, 41% believed that at least 1 of their patients hospitalized in the previous 6 months had experienced a preventable adverse event related to poor transfer of information at discharge |
Preen et al. (2005) [4] Australia |
| To determine the impact of a hospital co-ordinated discharge care plan | Prospective, randomized, controlled, clinical trial | N = 189; patients with chronic cardiorespiratory diagnoses recruited from respiratory, cardiovascular, and general medical wards at two tertiary hospitals | Patient and GP satisfaction (study-specific measure) |
|
Spandorfer et al. (1995) [48] USA |
| To assess patients’ comprehension of their ED discharge instructions |
| N = 217; ED patients | Patient comprehension (study-specific measure) |
|
van Walraven et al. (1999) [29] Canada |
| To compare discharge summaries created by voice dictation with those generated from a clinical database |
| N = 193; patients discharged from general internal medical service at a tertiary teaching hospital | Healthcare provider preference (study-specific measure) |
|
Archbold et al. (1998) [27] UK |
| To determine the preferences of GPs for standard dictated or computer-generated discharge summaries for patients with acute coronary syndromes | Questionnaire | N = 147; GPs | GP preference (study-specific measure) | Majority (68.5%) of GPs preferred the computerized summary and most (66.9%) thought it provided the clearer management plan and 70.8% recommended its use for other specialities |
Atzema et al. (2013) [16] Canada |
| To evaluate the effect of viewing an online video of diagnosis-specific discharge instructions on patient comprehension and recall of instructions | Prospective, single-centre, randomized controlled trial |
|
|
|
Bloch & Bloch (2013) [17] USA |
| To determine if adding video discharge instructions affects caregivers’ understanding of their child's ED visit, plan and follow-up | Randomized controlled trial |
|
| Brief video discharge instructions improved caregiver knowledge both in the ED and 2–5 days after discharge compared with written discharge instructions alone. Caregiver satisfaction with video discharge instructions was also greater than with written discharge instructions |
Branger et al. (1992) [38] The Netherlands |
| To study the effects of the introduction of electronic data interchange between primary and secondary care providers on speed of communication, efficiency of data handling, and satisfaction of general practitioners with communication | Comparison of traditional paper-based communication for laboratory reports and admission-discharge reports between hospital and general practitioners and electronic data interchange |
| GP satisfaction (study-specific measure) | Most GPs (15/ 24) reported that the use of electronic admission-discharge reports provided more accurate and complete information about the care delivered to their patients |
Braun et al. (2009) [42] Israel |
| To investigate whether TFU would increase patient satisfaction, improve compliance and reduce re-hospitalization rate | Randomized control trial | N = 400 | Patient satisfaction (study-specific measure) | Satisfaction was increased in the TFU group compared with control group by 6–12% in most fields. Most TFU patients reported that they performed the tests that were recommended at discharge and received explanations regarding their medications (86.9% (P = 0.02) and 96.7% (P < 0.0001), respectively). 93% of the patients in the TFU group as compared to 84% in the control group reported improvement in their symptoms. A non-significant trend towards fewer readmission was observed in the TFU group (26% vs. 35% P = 0.062) |
Cawthon, et al. 2012 USA |
| To investigate a care transition intervention to reduce medication errors and patients’ assessment of the intervention | Randomized control trial | N = 125 | Patient satisfaction (study-specific measure) |
|
Choi (2013) [18]USA |
| To examine the acceptability and comprehension of pictograph discharge instructions | Focus groups | N = 15; low-literate older adults hip replacement surgery recruited from community hospital | Patient comprehension (study-specific measure) | Participants perceived that the pictograph-based discharge instructions helped them understand the intended healthcare messages, especially for step-by-step procedures of discharge actions |
Choi et al. (2009) [37] Korea | MDIVs 3 = IT based | To evaluate the effectiveness of MDIVs in communicating discharge instructions to patients | Prospective controlled study | N = 161; N = 77 (printed instructions: P group) N = 84 (mobile video instructions: M group) patients with lacerations or sprains in a quaternary emergency centre |
| The mean of the correct answers on wound care in the questionnaire was 2.7 ± 0.7 in the M group and 2.4 ± 0.8 in the P group (P < 0.05). The rate of satisfaction was 90.5% in the M group and 90.9% in the P group (P < 0.05) |
D’Amore et al. (2011) [43] USA |
| To examine patients who received TFU for response differences on a mail satisfaction survey and 30-day readmission rates | Observational study | N = 10 559; patients from a large health system in southeast Texas | Patient satisfaction (study-specific measure) | Completion of a nursing call with a patient who reported a physician appointment was a significant predictor (P < 0.04) of lower 30-day readmissions |
Dedhia et al. (2009) [7] USA |
| To study the feasibility and effectiveness of a discharge planning intervention |
| N = 237; patients ≥65 years admitted to general medicine wards at three hospitals | Patient satisfaction (Activities of Daily Living (38); Care Transition Measure (39)) |
|
Graumlich et al. (2009) [28] USA |
| To measure patient and physician perceptions after discharge with computerized physician order entry software | Cluster randomized controlled trial | N = 631; inpatients discharged to home with high risk for readmission | Patient and physician perceptions (B-PREPARED questionnaire, Modified Physician-PREPARED scale, Satisfaction with Information About Medicines Scale, and study-specific measures) | When comparing patients assigned to discharge software vs. usual care, patient mean (standard deviation [SD]) scores for discharge preparedness were higher (17.7 [4.1] vs. 17.2 [4.0]; coefficient = 0.147; 95% CI = 0.005–0.289; P = 0.042), patient scores for satisfaction with medication information were unchanged (12.3 [4.8] vs. 12.1 [4.6]; coefficient = -0.212; 95% CI = −0.937–0.513; P = 0.567), and their outpatient physicians scored higher quality discharge (17.2 [3.8] vs. 16.5 [3.9]; coefficient = 0.133; 95% CI = 0.015–0.251; P = 0.027). Hospital physicians found mean effort to use discharge software was more difficult than the usual care (6.5 [1.9] vs. 7.9 [2.1]; P = 0.011) |
Grimmer & Moss (2001) [44] Australia |
| To describe the development, validity and application of a new instrument (PREPARED) for obtaining feedback from community consumers of discharge planning activities | Iterative qualitative and quantitative investigations | N = 834; patients aged over 65 years, with a range of conditions, recently discharged from hospital, and their carers | Patient satisfaction (patient and carer versions of PREPARED) | The instrument performed well when compared with interview data, the process and outcome domains were largely independent of each other, as were responses to PREPARED and SF-36 |
Heng et al. (2007) [47] Singapore |
| To evaluate patients’ and caregivers’ compliance to discharge instructions and their ability to recall minor head injury advice |
|
| Patient comprehension/ knowledge (study-specific measure) |
|
Heyworth (2014) [30] USA |
| To pilot an ambulatory medication reconciliation tool |
| N = 60; recently discharged patients from Veteran Affairs Hospital | Patient satisfaction (study-specific measures) | Overall, participants were enthusiastic about SMMRT; 90% said they would use SMMRT again |
Hickey et al. (1996) [41] USA |
| To improve patients’ satisfaction with discharge planning | Mixed-methods study: data from the hospital's Patient Satisfaction Survey, and phone interviews with patients |
| Patient satisfaction (study-specific measures) |
|
Hofflander et al. (2013) [40] Sweden |
| To investigate the experiences of primary healthcare nursing staff regarding discharge planning sessions and to identify their concerns regarding the use of video conferencing in the discharge planning session |
| N = 10; nursing staff from a primary healthcare centre | Healthcare provider preferences (study-specific measure) | Nursing staff in primary healthcare regarded the planning session as stressful, time-consuming and characterized by a lack of respect between nursing staff at the hospital and nursing staff in primary healthcare. They also described uncertainty and hesitation about using video conferences where patients might probably be the losers [patients do not attend video conference] and nursing staff the winners |
Horwitz et al. (2013) [45] USA |
| To conduct a multifaceted evaluation of transitional care from a patient-centred perspective | Prospective observational cohort study |
|
|
|
Lin et al. (2014) [49] Australia |
| To test whether a brief patient-directed discharge letter delivered during a brief discussion prior to discharge would improve patient understanding of their diagnosis and treatment plan | Prospective randomized controlled trial |
| Patient knowledge (study-specific questions) | Participants receiving the letter had an increase to almost full understanding of tests performed (P < 0.001) and to full understanding of post-discharge recommendations. This increase did not persist at 3 or 6 months |
Lindpaintner et al. (2013) [34] Switzerland |
| To test a discharge management intervention using nurse care managers | Single-blind, randomized, controlled interprofessional pilot |
| Healthcare provider and patient satisfaction (study-specific measure) | In the intervention group, satisfaction was higher among patients (P = 0.027) and caregivers (P = 0.008), and PCP rated discharge information higher (P = 0.031) |
Maslove et al. (2009) [33] Canada |
| To assess PCP satisfaction with an electronic discharge summary program as compared to conventional dictated discharge summaries | Cluster randomized trial | N = 209; patient discharges from an academic general medical service |
|
|
Mueller et al. (2015) [51] USA |
| To examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge | Retrospective cohort study | N = 233; patients discharged from a large tertiary care hospital |
| Templated discharge instructions had higher Flesch Reading Ease Level scores (71 vs. 57, P < 0.001) and lower Flesch–Kincaid Grade Level scores (5.6 vs. 7.6, P < 0.001), compared to clinician-generated discharge instructions |
Mutsch & Herbert (2010) [10] USA |
| To determine whether a written educational resource used by nurses at discharge could improve patient knowledge of cardiovascular medications | Cross-sectional, descriptive mixed-method study: pre- and post-intervention, focus groups, Interviews |
| Patient comprehension (study-specific measure) | More patients were able to verbalize correct medication, dose, schedule, and purpose post-intervention than pre-intervention (30% vs. 58%, chi-square = 7.955, df = 1, P-value = 0.005) |
Naylor et al. (2004) [31] USA |
| To examine the effectiveness of a transitional care intervention delivered by APNs to elders hospitalized with heart failure | Randomized, controlled trial |
| Patient satisfaction | For intervention patients, only short-term improvements were demonstrated in patient satisfaction (assessed at 2 and 6 weeks, P < 0.001) |
Naylor et al. (1999) [32] USA |
| To examine the effectiveness of an APN-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions |
|
| Patient satisfaction (study-specific measure) | There were no significant group differences in patient satisfaction |
Newnham et al. (2015) [35] Australia |
| To assess the feasibility and patient acceptance of a personalized interdisciplinary audio-visual record (CareTV) | Descriptive pilot study | N = 20; general medical patients |
|
|
O’Leary et al. (2009) [39] USA |
| To evaluate the effect of a newly-created electronic discharge summary |
|
| Healthcare provider satisfaction (study-specific measure) | Satisfaction with quality and timeliness of discharge summaries improved with the use of the electronic discharge summary (mean quality rating 3.04 versus 3.64; P < 0.001, mean timeliness rating 2.59 vs. 3.34; P < 0.001). A higher percentage of electronic discharge summaries were completed within 3 days of discharge as compared with dictated discharge summaries (44.8% vs. 74.1%; P < 0.001) |
O’Leary et al. (2006) [46] USA |
| To evaluate satisfaction with current discharge summaries, perceptions of preventable adverse events related to suboptimal information transfer, and the perceived need for the electronic discharge summary we plan to design | Physician survey | N = 226 physicians | Healthcare provider satisfaction (study-specific measure) | Only 19% of the participants were satisfied or very satisfied with timeliness, and only 32% were satisfied or very satisfied with the quality of discharge summaries. Overall, 41% believed that at least 1 of their patients hospitalized in the previous 6 months had experienced a preventable adverse event related to poor transfer of information at discharge |
Preen et al. (2005) [4] Australia |
| To determine the impact of a hospital co-ordinated discharge care plan | Prospective, randomized, controlled, clinical trial | N = 189; patients with chronic cardiorespiratory diagnoses recruited from respiratory, cardiovascular, and general medical wards at two tertiary hospitals | Patient and GP satisfaction (study-specific measure) |
|
Spandorfer et al. (1995) [48] USA |
| To assess patients’ comprehension of their ED discharge instructions |
| N = 217; ED patients | Patient comprehension (study-specific measure) |
|
van Walraven et al. (1999) [29] Canada |
| To compare discharge summaries created by voice dictation with those generated from a clinical database |
| N = 193; patients discharged from general internal medical service at a tertiary teaching hospital | Healthcare provider preference (study-specific measure) |
|
Discharge practice: 1 = written; 2 = person-based; 3 = IT based.
Table 3.
Study characteristics and discharge practices and outcomes identified in papers included in the review
Archbold et al. (1998) [27] UK |
| To determine the preferences of GPs for standard dictated or computer-generated discharge summaries for patients with acute coronary syndromes | Questionnaire | N = 147; GPs | GP preference (study-specific measure) | Majority (68.5%) of GPs preferred the computerized summary and most (66.9%) thought it provided the clearer management plan and 70.8% recommended its use for other specialities |
Atzema et al. (2013) [16] Canada |
| To evaluate the effect of viewing an online video of diagnosis-specific discharge instructions on patient comprehension and recall of instructions | Prospective, single-centre, randomized controlled trial |
|
|
|
Bloch & Bloch (2013) [17] USA |
| To determine if adding video discharge instructions affects caregivers’ understanding of their child's ED visit, plan and follow-up | Randomized controlled trial |
|
| Brief video discharge instructions improved caregiver knowledge both in the ED and 2–5 days after discharge compared with written discharge instructions alone. Caregiver satisfaction with video discharge instructions was also greater than with written discharge instructions |
Branger et al. (1992) [38] The Netherlands |
| To study the effects of the introduction of electronic data interchange between primary and secondary care providers on speed of communication, efficiency of data handling, and satisfaction of general practitioners with communication | Comparison of traditional paper-based communication for laboratory reports and admission-discharge reports between hospital and general practitioners and electronic data interchange |
| GP satisfaction (study-specific measure) | Most GPs (15/ 24) reported that the use of electronic admission-discharge reports provided more accurate and complete information about the care delivered to their patients |
Braun et al. (2009) [42] Israel |
| To investigate whether TFU would increase patient satisfaction, improve compliance and reduce re-hospitalization rate | Randomized control trial | N = 400 | Patient satisfaction (study-specific measure) | Satisfaction was increased in the TFU group compared with control group by 6–12% in most fields. Most TFU patients reported that they performed the tests that were recommended at discharge and received explanations regarding their medications (86.9% (P = 0.02) and 96.7% (P < 0.0001), respectively). 93% of the patients in the TFU group as compared to 84% in the control group reported improvement in their symptoms. A non-significant trend towards fewer readmission was observed in the TFU group (26% vs. 35% P = 0.062) |
Cawthon, et al. 2012 USA |
| To investigate a care transition intervention to reduce medication errors and patients’ assessment of the intervention | Randomized control trial | N = 125 | Patient satisfaction (study-specific measure) |
|
Choi (2013) [18]USA |
| To examine the acceptability and comprehension of pictograph discharge instructions | Focus groups | N = 15; low-literate older adults hip replacement surgery recruited from community hospital | Patient comprehension (study-specific measure) | Participants perceived that the pictograph-based discharge instructions helped them understand the intended healthcare messages, especially for step-by-step procedures of discharge actions |
Choi et al. (2009) [37] Korea | MDIVs 3 = IT based | To evaluate the effectiveness of MDIVs in communicating discharge instructions to patients | Prospective controlled study | N = 161; N = 77 (printed instructions: P group) N = 84 (mobile video instructions: M group) patients with lacerations or sprains in a quaternary emergency centre |
| The mean of the correct answers on wound care in the questionnaire was 2.7 ± 0.7 in the M group and 2.4 ± 0.8 in the P group (P < 0.05). The rate of satisfaction was 90.5% in the M group and 90.9% in the P group (P < 0.05) |
D’Amore et al. (2011) [43] USA |
| To examine patients who received TFU for response differences on a mail satisfaction survey and 30-day readmission rates | Observational study | N = 10 559; patients from a large health system in southeast Texas | Patient satisfaction (study-specific measure) | Completion of a nursing call with a patient who reported a physician appointment was a significant predictor (P < 0.04) of lower 30-day readmissions |
Dedhia et al. (2009) [7] USA |
| To study the feasibility and effectiveness of a discharge planning intervention |
| N = 237; patients ≥65 years admitted to general medicine wards at three hospitals | Patient satisfaction (Activities of Daily Living (38); Care Transition Measure (39)) |
|
Graumlich et al. (2009) [28] USA |
| To measure patient and physician perceptions after discharge with computerized physician order entry software | Cluster randomized controlled trial | N = 631; inpatients discharged to home with high risk for readmission | Patient and physician perceptions (B-PREPARED questionnaire, Modified Physician-PREPARED scale, Satisfaction with Information About Medicines Scale, and study-specific measures) | When comparing patients assigned to discharge software vs. usual care, patient mean (standard deviation [SD]) scores for discharge preparedness were higher (17.7 [4.1] vs. 17.2 [4.0]; coefficient = 0.147; 95% CI = 0.005–0.289; P = 0.042), patient scores for satisfaction with medication information were unchanged (12.3 [4.8] vs. 12.1 [4.6]; coefficient = -0.212; 95% CI = −0.937–0.513; P = 0.567), and their outpatient physicians scored higher quality discharge (17.2 [3.8] vs. 16.5 [3.9]; coefficient = 0.133; 95% CI = 0.015–0.251; P = 0.027). Hospital physicians found mean effort to use discharge software was more difficult than the usual care (6.5 [1.9] vs. 7.9 [2.1]; P = 0.011) |
Grimmer & Moss (2001) [44] Australia |
| To describe the development, validity and application of a new instrument (PREPARED) for obtaining feedback from community consumers of discharge planning activities | Iterative qualitative and quantitative investigations | N = 834; patients aged over 65 years, with a range of conditions, recently discharged from hospital, and their carers | Patient satisfaction (patient and carer versions of PREPARED) | The instrument performed well when compared with interview data, the process and outcome domains were largely independent of each other, as were responses to PREPARED and SF-36 |
Heng et al. (2007) [47] Singapore |
| To evaluate patients’ and caregivers’ compliance to discharge instructions and their ability to recall minor head injury advice |
|
| Patient comprehension/ knowledge (study-specific measure) |
|
Heyworth (2014) [30] USA |
| To pilot an ambulatory medication reconciliation tool |
| N = 60; recently discharged patients from Veteran Affairs Hospital | Patient satisfaction (study-specific measures) | Overall, participants were enthusiastic about SMMRT; 90% said they would use SMMRT again |
Hickey et al. (1996) [41] USA |
| To improve patients’ satisfaction with discharge planning | Mixed-methods study: data from the hospital's Patient Satisfaction Survey, and phone interviews with patients |
| Patient satisfaction (study-specific measures) |
|
Hofflander et al. (2013) [40] Sweden |
| To investigate the experiences of primary healthcare nursing staff regarding discharge planning sessions and to identify their concerns regarding the use of video conferencing in the discharge planning session |
| N = 10; nursing staff from a primary healthcare centre | Healthcare provider preferences (study-specific measure) | Nursing staff in primary healthcare regarded the planning session as stressful, time-consuming and characterized by a lack of respect between nursing staff at the hospital and nursing staff in primary healthcare. They also described uncertainty and hesitation about using video conferences where patients might probably be the losers [patients do not attend video conference] and nursing staff the winners |
Horwitz et al. (2013) [45] USA |
| To conduct a multifaceted evaluation of transitional care from a patient-centred perspective | Prospective observational cohort study |
|
|
|
Lin et al. (2014) [49] Australia |
| To test whether a brief patient-directed discharge letter delivered during a brief discussion prior to discharge would improve patient understanding of their diagnosis and treatment plan | Prospective randomized controlled trial |
| Patient knowledge (study-specific questions) | Participants receiving the letter had an increase to almost full understanding of tests performed (P < 0.001) and to full understanding of post-discharge recommendations. This increase did not persist at 3 or 6 months |
Lindpaintner et al. (2013) [34] Switzerland |
| To test a discharge management intervention using nurse care managers | Single-blind, randomized, controlled interprofessional pilot |
| Healthcare provider and patient satisfaction (study-specific measure) | In the intervention group, satisfaction was higher among patients (P = 0.027) and caregivers (P = 0.008), and PCP rated discharge information higher (P = 0.031) |
Maslove et al. (2009) [33] Canada |
| To assess PCP satisfaction with an electronic discharge summary program as compared to conventional dictated discharge summaries | Cluster randomized trial | N = 209; patient discharges from an academic general medical service |
|
|
Mueller et al. (2015) [51] USA |
| To examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge | Retrospective cohort study | N = 233; patients discharged from a large tertiary care hospital |
| Templated discharge instructions had higher Flesch Reading Ease Level scores (71 vs. 57, P < 0.001) and lower Flesch–Kincaid Grade Level scores (5.6 vs. 7.6, P < 0.001), compared to clinician-generated discharge instructions |
Mutsch & Herbert (2010) [10] USA |
| To determine whether a written educational resource used by nurses at discharge could improve patient knowledge of cardiovascular medications | Cross-sectional, descriptive mixed-method study: pre- and post-intervention, focus groups, Interviews |
| Patient comprehension (study-specific measure) | More patients were able to verbalize correct medication, dose, schedule, and purpose post-intervention than pre-intervention (30% vs. 58%, chi-square = 7.955, df = 1, P-value = 0.005) |
Naylor et al. (2004) [31] USA |
| To examine the effectiveness of a transitional care intervention delivered by APNs to elders hospitalized with heart failure | Randomized, controlled trial |
| Patient satisfaction | For intervention patients, only short-term improvements were demonstrated in patient satisfaction (assessed at 2 and 6 weeks, P < 0.001) |
Naylor et al. (1999) [32] USA |
| To examine the effectiveness of an APN-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions |
|
| Patient satisfaction (study-specific measure) | There were no significant group differences in patient satisfaction |
Newnham et al. (2015) [35] Australia |
| To assess the feasibility and patient acceptance of a personalized interdisciplinary audio-visual record (CareTV) | Descriptive pilot study | N = 20; general medical patients |
|
|
O’Leary et al. (2009) [39] USA |
| To evaluate the effect of a newly-created electronic discharge summary |
|
| Healthcare provider satisfaction (study-specific measure) | Satisfaction with quality and timeliness of discharge summaries improved with the use of the electronic discharge summary (mean quality rating 3.04 versus 3.64; P < 0.001, mean timeliness rating 2.59 vs. 3.34; P < 0.001). A higher percentage of electronic discharge summaries were completed within 3 days of discharge as compared with dictated discharge summaries (44.8% vs. 74.1%; P < 0.001) |
O’Leary et al. (2006) [46] USA |
| To evaluate satisfaction with current discharge summaries, perceptions of preventable adverse events related to suboptimal information transfer, and the perceived need for the electronic discharge summary we plan to design | Physician survey | N = 226 physicians | Healthcare provider satisfaction (study-specific measure) | Only 19% of the participants were satisfied or very satisfied with timeliness, and only 32% were satisfied or very satisfied with the quality of discharge summaries. Overall, 41% believed that at least 1 of their patients hospitalized in the previous 6 months had experienced a preventable adverse event related to poor transfer of information at discharge |
Preen et al. (2005) [4] Australia |
| To determine the impact of a hospital co-ordinated discharge care plan | Prospective, randomized, controlled, clinical trial | N = 189; patients with chronic cardiorespiratory diagnoses recruited from respiratory, cardiovascular, and general medical wards at two tertiary hospitals | Patient and GP satisfaction (study-specific measure) |
|
Spandorfer et al. (1995) [48] USA |
| To assess patients’ comprehension of their ED discharge instructions |
| N = 217; ED patients | Patient comprehension (study-specific measure) |
|
van Walraven et al. (1999) [29] Canada |
| To compare discharge summaries created by voice dictation with those generated from a clinical database |
| N = 193; patients discharged from general internal medical service at a tertiary teaching hospital | Healthcare provider preference (study-specific measure) |
|
Archbold et al. (1998) [27] UK |
| To determine the preferences of GPs for standard dictated or computer-generated discharge summaries for patients with acute coronary syndromes | Questionnaire | N = 147; GPs | GP preference (study-specific measure) | Majority (68.5%) of GPs preferred the computerized summary and most (66.9%) thought it provided the clearer management plan and 70.8% recommended its use for other specialities |
Atzema et al. (2013) [16] Canada |
| To evaluate the effect of viewing an online video of diagnosis-specific discharge instructions on patient comprehension and recall of instructions | Prospective, single-centre, randomized controlled trial |
|
|
|
Bloch & Bloch (2013) [17] USA |
| To determine if adding video discharge instructions affects caregivers’ understanding of their child's ED visit, plan and follow-up | Randomized controlled trial |
|
| Brief video discharge instructions improved caregiver knowledge both in the ED and 2–5 days after discharge compared with written discharge instructions alone. Caregiver satisfaction with video discharge instructions was also greater than with written discharge instructions |
Branger et al. (1992) [38] The Netherlands |
| To study the effects of the introduction of electronic data interchange between primary and secondary care providers on speed of communication, efficiency of data handling, and satisfaction of general practitioners with communication | Comparison of traditional paper-based communication for laboratory reports and admission-discharge reports between hospital and general practitioners and electronic data interchange |
| GP satisfaction (study-specific measure) | Most GPs (15/ 24) reported that the use of electronic admission-discharge reports provided more accurate and complete information about the care delivered to their patients |
Braun et al. (2009) [42] Israel |
| To investigate whether TFU would increase patient satisfaction, improve compliance and reduce re-hospitalization rate | Randomized control trial | N = 400 | Patient satisfaction (study-specific measure) | Satisfaction was increased in the TFU group compared with control group by 6–12% in most fields. Most TFU patients reported that they performed the tests that were recommended at discharge and received explanations regarding their medications (86.9% (P = 0.02) and 96.7% (P < 0.0001), respectively). 93% of the patients in the TFU group as compared to 84% in the control group reported improvement in their symptoms. A non-significant trend towards fewer readmission was observed in the TFU group (26% vs. 35% P = 0.062) |
Cawthon, et al. 2012 USA |
| To investigate a care transition intervention to reduce medication errors and patients’ assessment of the intervention | Randomized control trial | N = 125 | Patient satisfaction (study-specific measure) |
|
Choi (2013) [18]USA |
| To examine the acceptability and comprehension of pictograph discharge instructions | Focus groups | N = 15; low-literate older adults hip replacement surgery recruited from community hospital | Patient comprehension (study-specific measure) | Participants perceived that the pictograph-based discharge instructions helped them understand the intended healthcare messages, especially for step-by-step procedures of discharge actions |
Choi et al. (2009) [37] Korea | MDIVs 3 = IT based | To evaluate the effectiveness of MDIVs in communicating discharge instructions to patients | Prospective controlled study | N = 161; N = 77 (printed instructions: P group) N = 84 (mobile video instructions: M group) patients with lacerations or sprains in a quaternary emergency centre |
| The mean of the correct answers on wound care in the questionnaire was 2.7 ± 0.7 in the M group and 2.4 ± 0.8 in the P group (P < 0.05). The rate of satisfaction was 90.5% in the M group and 90.9% in the P group (P < 0.05) |
D’Amore et al. (2011) [43] USA |
| To examine patients who received TFU for response differences on a mail satisfaction survey and 30-day readmission rates | Observational study | N = 10 559; patients from a large health system in southeast Texas | Patient satisfaction (study-specific measure) | Completion of a nursing call with a patient who reported a physician appointment was a significant predictor (P < 0.04) of lower 30-day readmissions |
Dedhia et al. (2009) [7] USA |
| To study the feasibility and effectiveness of a discharge planning intervention |
| N = 237; patients ≥65 years admitted to general medicine wards at three hospitals | Patient satisfaction (Activities of Daily Living (38); Care Transition Measure (39)) |
|
Graumlich et al. (2009) [28] USA |
| To measure patient and physician perceptions after discharge with computerized physician order entry software | Cluster randomized controlled trial | N = 631; inpatients discharged to home with high risk for readmission | Patient and physician perceptions (B-PREPARED questionnaire, Modified Physician-PREPARED scale, Satisfaction with Information About Medicines Scale, and study-specific measures) | When comparing patients assigned to discharge software vs. usual care, patient mean (standard deviation [SD]) scores for discharge preparedness were higher (17.7 [4.1] vs. 17.2 [4.0]; coefficient = 0.147; 95% CI = 0.005–0.289; P = 0.042), patient scores for satisfaction with medication information were unchanged (12.3 [4.8] vs. 12.1 [4.6]; coefficient = -0.212; 95% CI = −0.937–0.513; P = 0.567), and their outpatient physicians scored higher quality discharge (17.2 [3.8] vs. 16.5 [3.9]; coefficient = 0.133; 95% CI = 0.015–0.251; P = 0.027). Hospital physicians found mean effort to use discharge software was more difficult than the usual care (6.5 [1.9] vs. 7.9 [2.1]; P = 0.011) |
Grimmer & Moss (2001) [44] Australia |
| To describe the development, validity and application of a new instrument (PREPARED) for obtaining feedback from community consumers of discharge planning activities | Iterative qualitative and quantitative investigations | N = 834; patients aged over 65 years, with a range of conditions, recently discharged from hospital, and their carers | Patient satisfaction (patient and carer versions of PREPARED) | The instrument performed well when compared with interview data, the process and outcome domains were largely independent of each other, as were responses to PREPARED and SF-36 |
Heng et al. (2007) [47] Singapore |
| To evaluate patients’ and caregivers’ compliance to discharge instructions and their ability to recall minor head injury advice |
|
| Patient comprehension/ knowledge (study-specific measure) |
|
Heyworth (2014) [30] USA |
| To pilot an ambulatory medication reconciliation tool |
| N = 60; recently discharged patients from Veteran Affairs Hospital | Patient satisfaction (study-specific measures) | Overall, participants were enthusiastic about SMMRT; 90% said they would use SMMRT again |
Hickey et al. (1996) [41] USA |
| To improve patients’ satisfaction with discharge planning | Mixed-methods study: data from the hospital's Patient Satisfaction Survey, and phone interviews with patients |
| Patient satisfaction (study-specific measures) |
|
Hofflander et al. (2013) [40] Sweden |
| To investigate the experiences of primary healthcare nursing staff regarding discharge planning sessions and to identify their concerns regarding the use of video conferencing in the discharge planning session |
| N = 10; nursing staff from a primary healthcare centre | Healthcare provider preferences (study-specific measure) | Nursing staff in primary healthcare regarded the planning session as stressful, time-consuming and characterized by a lack of respect between nursing staff at the hospital and nursing staff in primary healthcare. They also described uncertainty and hesitation about using video conferences where patients might probably be the losers [patients do not attend video conference] and nursing staff the winners |
Horwitz et al. (2013) [45] USA |
| To conduct a multifaceted evaluation of transitional care from a patient-centred perspective | Prospective observational cohort study |
|
|
|
Lin et al. (2014) [49] Australia |
| To test whether a brief patient-directed discharge letter delivered during a brief discussion prior to discharge would improve patient understanding of their diagnosis and treatment plan | Prospective randomized controlled trial |
| Patient knowledge (study-specific questions) | Participants receiving the letter had an increase to almost full understanding of tests performed (P < 0.001) and to full understanding of post-discharge recommendations. This increase did not persist at 3 or 6 months |
Lindpaintner et al. (2013) [34] Switzerland |
| To test a discharge management intervention using nurse care managers | Single-blind, randomized, controlled interprofessional pilot |
| Healthcare provider and patient satisfaction (study-specific measure) | In the intervention group, satisfaction was higher among patients (P = 0.027) and caregivers (P = 0.008), and PCP rated discharge information higher (P = 0.031) |
Maslove et al. (2009) [33] Canada |
| To assess PCP satisfaction with an electronic discharge summary program as compared to conventional dictated discharge summaries | Cluster randomized trial | N = 209; patient discharges from an academic general medical service |
|
|
Mueller et al. (2015) [51] USA |
| To examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge | Retrospective cohort study | N = 233; patients discharged from a large tertiary care hospital |
| Templated discharge instructions had higher Flesch Reading Ease Level scores (71 vs. 57, P < 0.001) and lower Flesch–Kincaid Grade Level scores (5.6 vs. 7.6, P < 0.001), compared to clinician-generated discharge instructions |
Mutsch & Herbert (2010) [10] USA |
| To determine whether a written educational resource used by nurses at discharge could improve patient knowledge of cardiovascular medications | Cross-sectional, descriptive mixed-method study: pre- and post-intervention, focus groups, Interviews |
| Patient comprehension (study-specific measure) | More patients were able to verbalize correct medication, dose, schedule, and purpose post-intervention than pre-intervention (30% vs. 58%, chi-square = 7.955, df = 1, P-value = 0.005) |
Naylor et al. (2004) [31] USA |
| To examine the effectiveness of a transitional care intervention delivered by APNs to elders hospitalized with heart failure | Randomized, controlled trial |
| Patient satisfaction | For intervention patients, only short-term improvements were demonstrated in patient satisfaction (assessed at 2 and 6 weeks, P < 0.001) |
Naylor et al. (1999) [32] USA |
| To examine the effectiveness of an APN-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions |
|
| Patient satisfaction (study-specific measure) | There were no significant group differences in patient satisfaction |
Newnham et al. (2015) [35] Australia |
| To assess the feasibility and patient acceptance of a personalized interdisciplinary audio-visual record (CareTV) | Descriptive pilot study | N = 20; general medical patients |
|
|
O’Leary et al. (2009) [39] USA |
| To evaluate the effect of a newly-created electronic discharge summary |
|
| Healthcare provider satisfaction (study-specific measure) | Satisfaction with quality and timeliness of discharge summaries improved with the use of the electronic discharge summary (mean quality rating 3.04 versus 3.64; P < 0.001, mean timeliness rating 2.59 vs. 3.34; P < 0.001). A higher percentage of electronic discharge summaries were completed within 3 days of discharge as compared with dictated discharge summaries (44.8% vs. 74.1%; P < 0.001) |
O’Leary et al. (2006) [46] USA |
| To evaluate satisfaction with current discharge summaries, perceptions of preventable adverse events related to suboptimal information transfer, and the perceived need for the electronic discharge summary we plan to design | Physician survey | N = 226 physicians | Healthcare provider satisfaction (study-specific measure) | Only 19% of the participants were satisfied or very satisfied with timeliness, and only 32% were satisfied or very satisfied with the quality of discharge summaries. Overall, 41% believed that at least 1 of their patients hospitalized in the previous 6 months had experienced a preventable adverse event related to poor transfer of information at discharge |
Preen et al. (2005) [4] Australia |
| To determine the impact of a hospital co-ordinated discharge care plan | Prospective, randomized, controlled, clinical trial | N = 189; patients with chronic cardiorespiratory diagnoses recruited from respiratory, cardiovascular, and general medical wards at two tertiary hospitals | Patient and GP satisfaction (study-specific measure) |
|
Spandorfer et al. (1995) [48] USA |
| To assess patients’ comprehension of their ED discharge instructions |
| N = 217; ED patients | Patient comprehension (study-specific measure) |
|
van Walraven et al. (1999) [29] Canada |
| To compare discharge summaries created by voice dictation with those generated from a clinical database |
| N = 193; patients discharged from general internal medical service at a tertiary teaching hospital | Healthcare provider preference (study-specific measure) |
|
Discharge practice: 1 = written; 2 = person-based; 3 = IT based.
Table 4
Summary of discharge communication methods and outcome measures by study
Archbold et al. [27] | √ | √ | ||||||
Atzema et al. [50] | √ | √ | √ | |||||
Bloch and Bloch [17] | √ | √ | √ | |||||
Branger et al. [38] | √ | √ | √ | |||||
Braun et al. [42] | √ | √ | ||||||
Cawthon et al. [36] | √ | √ | ||||||
Choi [18] | √ | √ | ||||||
Choi et al. [37] | √ | √ | √ | |||||
D’Amore et al. [43] | √ | √ | ||||||
Dedhia et al. [7] | √ | √ | ||||||
Graumlich et al. [28] | √ | √ | √ | √ | √ | √ | ||
Grimmer and Moss [44] | √ | √ | ||||||
Heng et al. [47] | √ | √ | √ | |||||
Heyworth et al. [30] | √ | √ | ||||||
Hickey et al. [41] | √ | √ | ||||||
Hofflander et al. [40] | √ | √ | ||||||
Horwitz et al. [45] | √ | √ | √ | |||||
Lin et al. [49] | √ | √ | ||||||
Lindpaintner et al. [34] | √ | √ | √ | |||||
Maslove et al. [33] | √ | √ | √ | √ | ||||
Mueller et al. [51] | √ | √ | ||||||
Mutsch and Herbert [10] | √ | √ | √ | |||||
Naylor et al. [31] | √ | √ | ||||||
Naylor et al. [32] | √ | √ | ||||||
Newnham et al. [35] | √ | √ | √ | |||||
O’Leary et al. [39] | √ | √ | √ | |||||
O’Leary et al. [46] | √ | √ | ||||||
Preen et al. [4] | √ | √ | √ | √ | ||||
Spandorfer et al. [48] | √ | √ | √ | |||||
van Walraven et al. [29] | √ | √ | √ |
Archbold et al. [27] | √ | √ | ||||||
Atzema et al. [50] | √ | √ | √ | |||||
Bloch and Bloch [17] | √ | √ | √ | |||||
Branger et al. [38] | √ | √ | √ | |||||
Braun et al. [42] | √ | √ | ||||||
Cawthon et al. [36] | √ | √ | ||||||
Choi [18] | √ | √ | ||||||
Choi et al. [37] | √ | √ | √ | |||||
D’Amore et al. [43] | √ | √ | ||||||
Dedhia et al. [7] | √ | √ | ||||||
Graumlich et al. [28] | √ | √ | √ | √ | √ | √ | ||
Grimmer and Moss [44] | √ | √ | ||||||
Heng et al. [47] | √ | √ | √ | |||||
Heyworth et al. [30] | √ | √ | ||||||
Hickey et al. [41] | √ | √ | ||||||
Hofflander et al. [40] | √ | √ | ||||||
Horwitz et al. [45] | √ | √ | √ | |||||
Lin et al. [49] | √ | √ | ||||||
Lindpaintner et al. [34] | √ | √ | √ | |||||
Maslove et al. [33] | √ | √ | √ | √ | ||||
Mueller et al. [51] | √ | √ | ||||||
Mutsch and Herbert [10] | √ | √ | √ | |||||
Naylor et al. [31] | √ | √ | ||||||
Naylor et al. [32] | √ | √ | ||||||
Newnham et al. [35] | √ | √ | √ | |||||
O’Leary et al. [39] | √ | √ | √ | |||||
O’Leary et al. [46] | √ | √ | ||||||
Preen et al. [4] | √ | √ | √ | √ | ||||
Spandorfer et al. [48] | √ | √ | √ | |||||
van Walraven et al. [29] | √ | √ | √ |
Table 4
Summary of discharge communication methods and outcome measures by study
Archbold et al. [27] | √ | √ | ||||||
Atzema et al. [50] | √ | √ | √ | |||||
Bloch and Bloch [17] | √ | √ | √ | |||||
Branger et al. [38] | √ | √ | √ | |||||
Braun et al. [42] | √ | √ | ||||||
Cawthon et al. [36] | √ | √ | ||||||
Choi [18] | √ | √ | ||||||
Choi et al. [37] | √ | √ | √ | |||||
D’Amore et al. [43] | √ | √ | ||||||
Dedhia et al. [7] | √ | √ | ||||||
Graumlich et al. [28] | √ | √ | √ | √ | √ | √ | ||
Grimmer and Moss [44] | √ | √ | ||||||
Heng et al. [47] | √ | √ | √ | |||||
Heyworth et al. [30] | √ | √ | ||||||
Hickey et al. [41] | √ | √ | ||||||
Hofflander et al. [40] | √ | √ | ||||||
Horwitz et al. [45] | √ | √ | √ | |||||
Lin et al. [49] | √ | √ | ||||||
Lindpaintner et al. [34] | √ | √ | √ | |||||
Maslove et al. [33] | √ | √ | √ | √ | ||||
Mueller et al. [51] | √ | √ | ||||||
Mutsch and Herbert [10] | √ | √ | √ | |||||
Naylor et al. [31] | √ | √ | ||||||
Naylor et al. [32] | √ | √ | ||||||
Newnham et al. [35] | √ | √ | √ | |||||
O’Leary et al. [39] | √ | √ | √ | |||||
O’Leary et al. [46] | √ | √ | ||||||
Preen et al. [4] | √ | √ | √ | √ | ||||
Spandorfer et al. [48] | √ | √ | √ | |||||
van Walraven et al. [29] | √ | √ | √ |
Archbold et al. [27] | √ | √ | ||||||
Atzema et al. [50] | √ | √ | √ | |||||
Bloch and Bloch [17] | √ | √ | √ | |||||
Branger et al. [38] | √ | √ | √ | |||||
Braun et al. [42] | √ | √ | ||||||
Cawthon et al. [36] | √ | √ | ||||||
Choi [18] | √ | √ | ||||||
Choi et al. [37] | √ | √ | √ | |||||
D’Amore et al. [43] | √ | √ | ||||||
Dedhia et al. [7] | √ | √ | ||||||
Graumlich et al. [28] | √ | √ | √ | √ | √ | √ | ||
Grimmer and Moss [44] | √ | √ | ||||||
Heng et al. [47] | √ | √ | √ | |||||
Heyworth et al. [30] | √ | √ | ||||||
Hickey et al. [41] | √ | √ | ||||||
Hofflander et al. [40] | √ | √ | ||||||
Horwitz et al. [45] | √ | √ | √ | |||||
Lin et al. [49] | √ | √ | ||||||
Lindpaintner et al. [34] | √ | √ | √ | |||||
Maslove et al. [33] | √ | √ | √ | √ | ||||
Mueller et al. [51] | √ | √ | ||||||
Mutsch and Herbert [10] | √ | √ | √ | |||||
Naylor et al. [31] | √ | √ | ||||||
Naylor et al. [32] | √ | √ | ||||||
Newnham et al. [35] | √ | √ | √ | |||||
O’Leary et al. [39] | √ | √ | √ | |||||
O’Leary et al. [46] | √ | √ | ||||||
Preen et al. [4] | √ | √ | √ | √ | ||||
Spandorfer et al. [48] | √ | √ | √ | |||||
van Walraven et al. [29] | √ | √ | √ |
Discharge communication practices
The most common practice for communicating discharge information was IT based methods which included both discharge information such as diagnosis, treatment and medication regimes generated by computer [4, 27–29, 33, 38, 39, 46, 51], and the use of a website [30], audio-visual recording of discharge information [17, 35, 37, 50] or video conferencing between hospital and primary care providers [40] in the discharge process.
Person-based methods were the second most common way of communicating discharge information to a patient, their family or healthcare provider. Discharge information was delivered verbally by a nurse [4, 10, 31, 32, 34, 43], pharmacist [36], ED staff [47], the attending physician [28, 41, 45, 48] and unspecified healthcare providers [42].
Written methods included printed or handwritten summaries [7, 10, 18, 29, 33, 38, 39, 44, 47–49] which were mailed, transferred electronically or hand delivered to the patient or primary healthcare provider.
Effectiveness of the identified discharge communication methods
It is difficult to synthesize the effectiveness of each discharge method in terms of the outcomes assessed given the variability in research design, populations, interventions and time-points of the studies reviewed. Instead we compared the effectiveness of the identified methods in response to our three identified measures: healthcare provider and patient preferences and satisfaction, and patient comprehension. We have framed this evaluation in terms of three questions we identified as practically important to healthcare providers.
Which discharge communication method(s) do healthcare providers and patients prefer and why?
A survey of GPs in the UK aimed to determine their preference for standard dictated or computer-generated discharge summaries for acute coronary syndrome patients found that over two-thirds (69%) of GPs preferred the computerized summary for its comprehensive content, concise style, access to relevant information and clarity [27]. Hospital physicians in Canada also preferred computer-based systems for generating discharge summaries as they are faster and less burdensome to generate [29].
A cluster randomized clinical trial in the USA measured physician and patient perceptions of a computerized physician entry discharge software versus usual care (handwritten) discharge and found the discharge software was rated more positively by patients and outpatient physicians [28]. Outpatient physicians perceived the communication generated by the software to be an improvement over the handwritten process. However, hospital physicians perceived the software to be more difficult to use as it did not integrate with the hospital electronic medical record. Consequently, hospital physician users had to re-enter patient demographic data and prescription data that already existed in the electronic record.
A qualitative investigation of the concerns of Swedish primary healthcare nurses identified they were ambiguous about the use of video conferencing in the discharge planning session and found the process stressful and time-consuming [40].
Collectively, physicians and patients preferred computer-generated summaries over those generated by other means as they provide information quickly in a structured, accessible format. However, discharge software needs to be easy to use and time efficient.
Which discharge communication practices increase healthcare provider and patient satisfaction, and why?
An observational study (record audit) of paper and IT-based discharge methods in the Netherlands reported electronic communication increased GP satisfaction due to its increased accuracy and speed of reporting [38]. Satisfaction with quality and timeliness of discharge summaries also improved with the use of the electronic discharge summary in a pre–post evaluation of a new electronic discharge summary conducted in the USA [39]. Similarly, although Canadian hospital physicians found an electronic discharge summary program to be easier to use than conventional dictation there was no significant improvement in their satisfaction [33]. Improvements in satisfaction may increase as physicians become more familiar with the program and it is incorporated into routine practice.
Patients in a mixed-methods study in the USA which investigated the use of a web portal based medication reconciliation tool also reported positive experiences including ease of use, rapid access and ability to communicate easily with healthcare provider after discharge [30]. An Australian intervention study using computer-generated discharge summaries showed patients had improved involvement in discharge planning, health service access, confidence with discharge procedures and opinion of discharge based on previous experiences [4]. However, a cluster randomized controlled trial in the USA found no improvement in patient satisfaction with medication information received at discharge with a computerized physician entry discharge software [28].
Overall, computer-generated discharge methods improve the extent and speed of hospital and primary care provider communication yielding increased satisfaction for healthcare providers and patients.
Patients also expressed satisfaction in an Australian pilot study of an audio-visual recording summarizing their diagnosis and treatment plan given to the patient at the time of discharge [35]. A randomized control trial in Canada which evaluated the effect of viewing an online video of diagnosis-specific discharge instructions also found that patients who viewed the videos felt they were a helpful addition to care [50]. In another randomized control trial in the USA, caregivers of children who attended an ED expressed greater satisfaction with video than with written discharge instructions [17]. Evaluation of the effectiveness of mobile discharge instruction videos (MDIVs) in communicating discharge instructions to patients with lacerations or sprains attending a Korean ED found that patients were highly satisfied with the MDIVs and they appeared to improve patients’ comprehension of their discharge instructions [37].
The use of video in the provision of discharge summaries and instructions appears beneficial to patients and their carers providing them with clear and simple information which assists them to comprehend and remember key components of the patient's discharge.
Significantly higher satisfaction with discharge communication processes was also reported by patients and family caregivers in Switzerland receiving a discharge management intervention using nurse care managers compared with those receiving usual care [34]. In a mixed-methods study in the US patients who received a discharge concierge service reported greater satisfaction than those who received standard care [41]. Telephone follow-up (TFU) from the hospital one week and one month after discharge also increased patient satisfaction in a randomized control trial in Israel as well as improving patients’ understanding of their discharge recommendations [42]. A pharmacist-led care transition intervention in the US provided patients with easy-to-understand instructions and strategies to manage their post-discharge medication. The majority of patients reported that it was a ‘very helpful’ intervention and felt more comfortable discussing their medications with their primary care providers as a result of the intervention [36]. A transitional care intervention in the USA for elderly heart failure patients hospitalized which included home visits and telephone availability by advanced practice nurses (APNs) showed a short-term (2 and 6 weeks) improvement in patient satisfaction [31].
-
However, no difference in patient satisfaction was found in the intervention study by Naylor et al. [32] in which patients received a comprehensive discharge planning and home follow-up protocol implemented by APNs. Similarly, TFU by a nurse was not a significant predictor of patient satisfaction in a large US study [43]. Patients in both the intervention and control groups in these studies were highly satisfied with the care received and this may explain why little improvement in patient satisfaction was identified as a result of the nurse follow-ups.
There is mixed evidence that post-discharge support, such as TFU, increases patient satisfaction. However, the individualized care provided in such interventions does appear to improve communication between the hospital, the patient, their carers and primary healthcare providers.
Do any discharge methods improve patient comprehension and knowledge?
There was conflicting evidence about the impact of delivery method on patient comprehension of their medical condition and discharge instructions.
A printed information booklet given to patients in the US improved knowledge of their medications (correct medication, dose, schedule and purpose) [10]. Pictograph-based discharge instructions also increased patient understanding especially for patients with low literacy skills and immigrants [18]. An Australian study found that a simple patient-directed letter delivered during a brief discussion with the clinician at discharge improved patient understanding of their hospitalization and post-discharge recommendations [49].
Another Australian study reported an audio-visual recording of the discharge summary (CareTV) improved patient recall of their diagnosis, medication and follow-up treatment plans [35]. Similarly, a randomized control trial in Canada found that patients who viewed an online video of their discharge instructions had better understanding of their diagnosis and subsequent care [50]. Another RCT in the USA found that brief video discharge instructions improved caregiver knowledge compared with written discharge instructions [17]. MDIVs were also found to improve Korean patients’ comprehension of their discharge instructions [37].
In a US study, Spandorfer et al. [48] found that patient comprehension improved when instructions were given verbally by the discharging physician whereas in Singapore Heng et al. [47] found no difference regardless of whether discharge advice was given verbally, in printed form, or a combination of both. Possible reasons for this finding are that the caregivers did not understand the discharge advice or did not bother to review the instructions.
Overall, findings suggest utilizing technology to deliver information to patients and their caregivers improves their understanding of the patient's condition and discharge instructions. Technology, in particular audio-visual technology, allows patients and carers to easily access information about their diagnosis and treatment when and as often as required.
Discussion
Effective communication between hospitals and primary healthcare providers that also meets the needs of their patients is important for providing continuity of care [5, 38]. This systematic review found variability in the way information is transferred to patients and primary care providers at hospital discharge. Three main methods were identified: 1. IT based; 2. Person-based and 3. Written. In the reviewed studies, IT-based methods were the most commonly used and included computer-generated information, website or video-based summaries, followed by person-based methods with the discharge information delivered by a healthcare provider. Written methods were the least used.
The patient and healthcare provider preferences and satisfaction results for each method were consistent across all study designs evaluated. Both patients and providers preferred discharge practices that provided relevant, concise, and personalized information, and were easily accessible and efficient. In particular, computer-generated summaries were preferred by physicians and patients due their structured format and time efficiency, and resulted higher levels of satisfaction for both healthcare providers and patients. Video-based discharge summaries and instructions were also beneficial in improving patients and caregiver comprehension of patient's diagnosis and discharge instructions. These findings suggest that utilizing technology to deliver information improves patient understanding of their condition and discharge instructions.
The primary limitations of this review relate to the variability in research design, populations, types of interventions and time-points of the studies reviewed. This impeded the synthesis of their findings. Further, many of the outcome measures were only assessed by a few studies. The studies reviewed were conducted in 10 countries with different national health systems which may also make comparisons difficult. These limitations restrict the generalizations that can be made from the findings.
Directions for future research
The findings of this review indicate the need for further research to inform the development of innovative tools to provide information at hospital discharge. The use of IT has been proposed as a way of enhancing the quality and transmission of discharge summaries [2]. Yet only a few studies have assessed the effectiveness of IT solutions such as video-based discharge summaries despite evidence that the provision of information with video is helpful in patient comprehension and decision-making [52–56]. The personalized interdisciplinary audio-visual record (CareTV) designed to facilitate effective communication with patients, family, carers and other care team at hospital discharge also improved patient knowledge and satisfaction [35]. Redesigning discharge practices in combination with IT solutions has the potential to improve communication; make discharge summaries more accessible and transparent for patients, their families, carers and healthcare providers; and achieve higher quality of care and outcomes for patients [40, 57]. This study suggests that a single format of discharge summary is unlikely to fulfil all expectations and needs of patients and healthcare providers. A combination of discharge communication tools may be required and further research should seek the most effective combinations of tools for particular categories of patients.
Conclusion and implications for clinical practice
Improvements are needed in the processes used for transferring information to patients and their primary healthcare providers at hospital discharge. Well-designed IT solutions may improve communication, coordination and retention of information, and lead to improved outcomes for patients, their families, caregivers and primary healthcare providers as well as expediting the task for hospital staff. Further research is required to inform the development of processes for provision of information at the time of transfer of care that meet the needs of both patients and their healthcare providers.
Funding
This work was supported by a grant from the Victorian Department of Health and Human Services. The Victorian Department of Health and Human Services had no role in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. A.B.'s salary was funded by a Career Development Fellowship from the National Health and Medical Research Council (NHMRC) (APP1067236).
References
1
Chen
Y
,Brennan
N
,Magrabi
F
.Is email an effective method for hospital discharge communication? A randomized controlled trial to examine delivery of computer-generated discharge summaries by email, fax, post and patient hand delivery
.
Int J Med Inform
2010
;
79
:
167
–
72
.
2
Kripalani
S
,LeFevre
F
,Phillips
C
et al. .Deficits in communication and information transfer between hospital based and primary care physicians: implications for patient safety and continuity of care
.
JAMA
2007
;
297
:
831
–
41
.
3
Shepperd
S
,Parkes
J
,McClaran
J
et al. .Discharge planning from hospital to home
.
Cochrane Database Syst Rev
2004
;
1
:
1
–
38
.
4
Preen
DB
,Bailey
BES
,Wright
A
et al. .Effects of a multidisciplinary, post-discharge continuance of care intervention on quality of life, discharge satisfaction, and hospital length of stay: a randomized controlled trial
.
Int J Qual Health Care
2005
;
17
:
43
–
51
.
5
Bauer
M
,Fitzgerald
L
,Haesler
E
et al. .Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence
.
J Clin Nurs
2009
;
18
:
2539
–
46
.
6
Davis
MM
,Devoe
M
,Kansagara
D
et al. .‘Did I do as best as the system would let me?’ Healthcare professional views on hospital to home care transitions
.
J Gen Intern Med
2012
;
27
:
1649
–
56
.
7
Dedhia
P
,Kravet
S
,Bulger
J
et al. .A quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes
.
J Am Geriatr Soc
2009
;
57
:
1540
–
6
.
8
Greenwald
J
,Denham
C
,Jack
B
.The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process
.
J Patient Saf
2007
;
3
:
97
–
106
.
9
Ouchida
K
,LoFaso
VM
,Capello
CF
et al. .Fast forward rounds: an effective method for teaching medical students to transition patients safely across care settings
.
J Am Geriatr Soc
2009
;
57
:
910
–
7
.
10
Mutsch
KS
,Herbert
M
.Medication discharge planning prior to hospital discharge
.
Qual Manag J
2010
;
17
:
25
.
11
Phillips
CO
,Wright
SM
,Kern
DE
et al. .Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure a meta-analysis
.
JAMA
2004
;
291
:
1358
.
12
Chugh
A
,Williams
MV
,Grigsby
J
et al. .Better transitions: improving comprehension of discharge instructions
.
Front Health Serv Manage
2009
;
25
:
3
.
13
Saidinejad
M
,Zorc
J
.Mobile and web-based education: delivering emergency department discharge and aftercare instructions
.
Pediatr Emerg Care
2014
;
30
:
211
–
6
.
14
Regalbuto
R
,Maurer
MS
,Chapel
D
et al. .Joint Commission requirements for discharge instructions in patients with heart failure: is understanding important for preventing readmissions?
J Card Fail
2014
;
20
:
641
–
9
.
15
Ziaeian
B
,Araujo
K
,Van Ness
P
et al. .Medication reconciliation accuracy and patient understanding of intended medication changes on hospital discharge
.
J Gen Intern Med
2012
;
27
:
1513
–
20
.
16
Atzema
C
,Austin
P
,Wu
L
et al. .Speak fast, use jargon, and don't repeat yourself: a randomized trial assessing the effectiveness of online videos to supplement emergency department discharge instructions
.
PLoS ONE
2013
;
8
:
e77057
.
17
Bloch
S
,Bloch
A
.Using video discharge instructions as an adjunct to standard written instructions improved caregivers’ understanding of their child's emergency department visit, plan, and follow-up: a randomized controlled trial
.
Pediatr Emerg Care
2013
;
29
:
699
–
704
.
18
Choi
J
.Older adults’ perceptions of pictograph-based discharge instructions after hip replacement surgery
.
J Gerontol Nurs
2013
;
39
:
48
–
54
.
19
Coleman
E
,Chugh
A
,Williams
M
et al. .Understanding and execution of discharge instructions
.
Am J Med Qual
2013
;
28
:
383
–
91
.
20
Garasen
H
,Johnsen
R
.The quality of communication about older patients between hospital physicians and general practitioners: a panel study assessment
.
BMC Health Serv Res
2007
;
7
:
133
.
21
Balaban
RB
,Weissman
JS
,Samuel
PA
et al. .Redefining and redesigning hospital discharge to enhance patient care: a randomized controlled study
.
J Gen Intern Med
2008
;
23
:
1228
–
33
.
22
Bomba
DT
,Prakash
R
.A description of handover processes in an Australian public hospital
.
Aust Health Rev
2005
;
29
:
1
.
23
Moher
D
,Liberati
A
,Tetzlaff
J
et al. .The PRISMA Group
.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
.
PLoS Med
2009
;
151
:
264
–
9
.
25
Kmet
LM
,Lee
RC
,Cook
LS
.Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields
.
Edmonton, Alberta, Canada
:
Alberta Heritage Foundation for Medical Research
,
2004
.
26
Dixon-Woods
M
,Bonas
S
,Booth
A
et al. .How can systematic reviews incorporate qualitative research? A critical perspective
.
Qual Res
2006
;
6
:
27
–
44
.
27
Archbold
RA
,Laji
K
,Suliman
A
et al. .Evaluation of a computer-generated discharge summary for patients with acute coronary syndromes
.
Br J Gen Pract
1998
;
48
:
1163
–
4
.
28
Graumlich
JF
,Novotny
NL
,Nace
GS
et al. .Patient and physician perceptions after software-assisted hospital discharge: cluster randomized trial
.
J Hosp Med
2009
;
4
:
356
–
63
.
29
van Walraven
C
,Laupacis
A
,Ratika
S
et al. .Dictated versus database-generated discharge summaries: a randomized clinical trial
.
Can Med Assoc J
1999
;
160
:
319
–
26
.
30
Heyworth
L
,Paquin
AM
,Clark
J
et al. .Engaging patients in medication reconciliation via a patient portal following hospital discharge
.
J Am Med Inform Assoc
2014
;
21
:
e157
–
62
.
31
Naylor
MD
,Brooten
DA
,Campbell
RL
et al. .Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial
.
J Am Geriatr Soc
2004
;
52
:
675
–
84
.
32
Naylor
M
,Brooten
D
,Campbell
R
et al. .Comprehensive discharge planning and home follow-up of hospitalised elders
.
JAMA
1999
;
281
:
613
–
20
.
33
Maslove
DM
,Leiter
RE
,Griesman
J
et al. .Electronic versus dictated hospital discharge summaries: a randomized controlled trial
.
J Gen Intern Med
2009
;
24
:
995
–
1001
.
34
Lindpaintner
LS
,Gasser
JT
,Schramm
MS
et al. .Discharge intervention pilot improves satisfaction for patients and professionals
.
Eur J Intern Med
2013
;
24
:
756
–
62
.
35
Newnham
H
,Gibbs
H
,Ritchie
E
et al. .A feasibility study of the provision of a personalised interdisciplinary audiovisual summary to facilitate care transfer care at hospital discharge: Care Transfer Video (CareTV)
.
Int J Qual Health Care
2015
;
27
:
105
–
9
.
36
Cawthon
C
,Walia
S
,Osborn
CY
et al. .Improving care transitions: the patient perspective
.
J Health Commun
2012
;
17
:
312
–
24
.
37
Choi
S
,Ahn
J
,Lee
D
et al. .The Effectiveness of Mobile Discharge Instruction Videos (MDIVs) in communicating discharge instructions to patients with lacerations or sprains
.
South Med J
2009
;
102
:
239
–
47
.
38
Branger
P
,van der Wouden
J
,Schudel
B
et al. .Electronic communication between providers of primary and secondary care
.
BMJ
1992
;
305
:
1068
–
70
.
39
O’Leary
KJ
,Liebovitz
DM
,Feinglass
J
et al. .Creating a better discharge summary: Improvement in quality and timeliness using an electronic discharge summary
.
J Hospital Med
2009
;
4
:
219
–
25
.
40
Hofflander
M
,Nilsson
L
,Eriksén
S
et al. .Discharge planning: narrated by nursing staff in primary healthcare and their concerns about using video conferencing in the planning session—An interview study
.
J Nurs Educ Pract
2013
;
3
:
88
–
98
.
41
Hickey
M
,Kleefield
S
,Pearson
S
et al. .Payer-hospital collaboration to improve patient satisfaction with hospital discharge
.
Jt Comm J Qual Improv
1996
;
22
:
336
–
44
.
42
Braun
E
,Baidusi
A
,Alroy
G
et al. .Telephone follow-up improves patients satisfaction following hospital discharge
.
Eur J Intern Med
2009
;
20
:
221
–
5
.
43
D’Amore
J
,Murray
J
,Powers
H
et al. .Does telephone follow-up predict patient satisfaction and readmission?
Popul Health Manag
2011
;
14
:
249
–
55
.
44
Grimmer
K
,Moss
J
.The development, validity and application of a new instrument to assess the quality of discharge planning activities from the community perspective
.
Int J Qual Health Care
2001
;
13
:
109
–
16
.
45
Horwitz
LI
,Moriarty
JP
,Chen
C
et al. .Quality of discharge practices and patient understanding at an academic medical center
.
JAMA Intern Med
2013
;
173
:
1715
–
22
.
46
O’Leary
KJ
,Liebovitz
DM
,Feinglass
J
et al. .Outpatient physicians’ satisfaction with discharge summaries and perceived need for an electronic discharge summary
.
J Hosp Med
2006
;
1
:
317
–
20
.
47
Heng
K
,Tham
K
,How
K
et al. .Recall of discharge advice given to patients with minor head injury presenting to a Singapore emergency department
.
Singapore Med J
2007
;
48
:
1107
–
10
.
48
Spandorfer
J
,Karras
D
,Hughes
L
et al. .Comprehension of discharge instructions by patients in an urban emergency department
.
Ann Emerg Med
1995
;
25
:
71
–
4
.
49
Lin
R
,Gallagher
R
,Spinaze
M
et al. .Effect of a patient-directed discharge letter on patient understanding of their hospitalisation
.
Intern Med J
2014
;
44
:
851
–
7
.
50
Atzema
CL
,Austin
PC
,Wu
L
et al. .Speak fast, use jargon, and don't repeat yourself: a randomized trial assessing the effectiveness of online videos to supplement emergency department discharge instructions
.
PLoS ONE [Electronic Resource]
2013
;
8
:
e77057
.
51
Mueller
S
,Giannelli
K
,Boxer
R
et al. .Readability of patient discharge instructions with and without the use of electronically available disease-specific templates
.
J Am Med Inform Assoc
2015
;
22
:
857
–
63
.
52
Volandes
A
,Lehmann
L
,Cook
E
et al. .Using video images of dementia in advance care planning
.
Arch Intern Med
2007
;
167
:
828
–
33
.
53
Volandes
A
,Paasche-Orlow
M
,Barry
M
et al. .Video decision support tool for advance care planning in dementia: randomised controlled trial
.
BMJ
2009
;
338
:
b2159
.
54
Morgan
M
,Deber
R
,Llewellyn-Thomas
H
et al. .Randomised, controlled trial of an interactive vidoedisc decision aid for patients with ischemic heart disease
.
J Gen Intern Med
2000
;
15
:
685
–
93
.
55
Houts
P
,Doak
C
,Doak
L
et al. .The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence
.
Patient Educ Couns
2006
;
61
:
173
–
90
.
56
Frosch
D
,Kaplan
R
,Felitti
V
.A randomised controlled trial comparing internet and video to facilitate patient education for men considering the prostate specific antigen test
.
J Gen Intern Med
2003
;
18
:
781
–
7
.
57
Gurses
AP
,Xiao
Y
.A systematic review of the literature on multidisciplinary rounds to design information technology
.
J Am Med Inform Assoc
2006
;
13
:
267
–
76
.
© The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail:
© The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail:
Topic:
- caregivers
- computers
- health personnel
- information sciences
- medline
- patient discharge
- peer review
- personnel, hospital
- primary health care
- telephone
- communication and information technology
- coordination
- patient preferences
- discharge instructions
- english