Study: Hospital discharge processes still need work

New research reveals hospitals need clearer, well-designed discharge processes for older patients, noting that patient satisfaction with the discharge process doesn't indicate how well patients actually understand the reason for hospitalization and post-discharge care goals, concludes a new study in JAMA Internal Medicine.

Researchers talked to about 400 patients 65 years and older discharged from 1,541-bed Yale-New Haven (Conn.) Hospital between May 2009 and April 2010 about their experience, responses they compared to what was written in their medical charts and their discharge instructions, reported Reuters.

Only 218 patients (59.6 percent) could accurately describe their diagnosis in post-discharge interviews, while discharge instructions included 99 written reasons for hospitalization (26.3 percent) that did not use language likely to be comprehensible to patients.

For example, instructions used the medical term "myocardial infarction" instead of "heart attack," Reuters noted.

The study also showed the discharge process is often rushed and abrupt, as 30 percent of patients had less than one day's warning of their upcoming discharge and 40 percent didn't fully understand why they were admitted, according to an accompanying commentary.

"Patients were very positive, but when we asked them about actual facts, they could not tell us," Leora Horwitz, M.D., lead study author from the Yale School of Medicine, told Reuters.

The commentary recommended hospitals establish a discharge team comprised of geriatric specialists, advanced practices nurses and pharmacists, as well promote equal information sharing among physicians, the discharge team, the outpatient primary care medical home, home care providers, the patient, their family and caregivers.

Moreover, hospitals should treat the patient discharge process as a transitional care process, and not an isolated event, that begins with the decision to admit and continues through the hospital stay and the post-discharge period with follow-up patient contact, according to the commentary.

The Centers for Medicare & Medicaid Service in May revised its guidance on discharge planning to encourage greater communication among healthcare professionals, facilities, patients and support staff. CMS also said hospitals are responsible for the initial implementation of the discharge plan, including arranging the transfer to the next setting and providing the patient with information about treatment goals in that setting, FierceHealthcare previously reported.

For more:
- here's the abstract
- read the related commentary
- here's the Reuters article