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Background:
Patient-centered discharge tools provide an opportunity to engage patients, enhance patient understanding, and improve capacity for self-care and postdischarge outcomes.
Purpose:
To review studies that engaged patients in the design or delivery of discharge instruction tools and that tested their effect among hospitalized patients....
Contexts in source publication
Context 1
... studies tested the impact of educational discharge interventions (28 of 30 studies) (Table 1). Quite often, it was a member of the research team who carried out the pa- tient education. ...
Similar publications
Background:
The aim of the present study was to determine the effectiveness of a self-care education (SCE) discharge program with telephone follow-ups in managing hypertension (HTN) in older patients.
Methods:
The study was conducted on 56 older patients with HTN who had recently been discharged from the cardiac wards of hospitals in Isfahan, Ir...
Citations
... Patient-centred discharge tools provide an opportunity to engage patients. A systematic review of these tools found that they can increase comprehension but that further research is needed on patient experience and adherence to instructions (Okrainec et al., 2017). Project RED (ReEngineered Discharge) in the U.S. reported a positive impact on perceptions of instructions on self-care (Cancino et al., 2017). ...
The objective of this study was to evaluate the implementation and outcomes of a quality improvement intervention for older adults discharged from hospital to home, that used a patient-centred discharge education tool called the Patient-Centered Discharge Plan (PCAP). We conducted a pre-post evaluation of PCAP implementation among patients 65 years and older and discharged home from an acute medical or geriatric admission at two general hospitals. Two patient cohorts, PRE and POST, were analysed using administrative data (n = 3,309) and post-discharge structured interviews in a subset of patients (n = 326). Outcomes were 90-day readmissions and return emergency department (ED) visits, and transition experiences (10-item scale). The PCAP was provided to 20 per cent of 1,683 patients. Transition experience scores increased from PRE to POST at both hospitals (adjusted beta 1.3; 95% CI: 0.8, 1.7), and return ED visits declined in one of the two hospitals (adjusted decline 1.3%; 95% CI: -3.7, 6.2). In conclusion, dedicated resources are needed to support future PCAP implementation.
... After acute care admission, patients often receive inadequate information about discharge instructions [15], whereas others have unanswered questions [16]. Some studies have described how patients may experience poor retention of verbal instructions during post-discharge periods [17,18], and how effective education and written discharge instructions may help improve a patient's understanding and facilitate transition from hospital to home [19][20][21][22][23]. A critical gap that has been identified is poor communication between clinicians and patients and their caregivers [24,25]. ...
... This may include education for patients and their caregivers regarding their health conditions, medication, and common symptoms; a mechanism for exchanging questions and obtaining feedback from patients; and guidance on when to seek appropriate medical care or follow-ups. Using integrated [29] and holistic patient and caregiver interventions [19][20][21][22][23]30], and digital platforms [31] in particular, can help minimize avoidable readmissions and other challenges with the transition of patients from hospital to their homes. Digital health interventions should be inclusive and consider unique patient characteristics such as age, disability, and level of cognition to optimize success [32]. ...
Background:
With the increased adoption of technology, the use of digital health interventions in health care settings has increased. Patient-clinician digital health interventions have the potential to improve patient care, especially during important transitions between hospital and home. Digital health interventions can provide support to patients during these transitions, thereby leading to better patient outcomes.
Objective:
This scoping review aims to explore the available literature, specifically (1) to examine the impact of platform-based digital health interventions focused on care transitions on patient outcomes, and (2) to identify the barriers to and enablers for the uptake and implementation of these digital health interventions.
Methods:
This protocol was developed based on Arksey and O'Malley's, Levac and colleagues', and JBI scoping review methodologies, and it has been reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for the Scoping Reviews) format. The search strategies were developed for 4 databases: MEDLINE, CINAHL, EMBASE, and the Cochrane Central Register of Controlled Trials by using key words such as "hospital to home transition" and "platform-based digital health." Studies involving patients 16 years or older that used a platform-based digital health intervention during their hospital to home transition will be included in this review. Two reviewers will independently screen articles for eligibility by using a 2-stage process (ie, title and abstract screening and full-text screening). We expect to refine the eligibility criteria during the title and abstract screening process as we anticipate retrieving a significant number of articles. In addition, we will also perform a targeted search of the grey literature, as well as data extraction. Data analysis will consist of a narrative and descriptive synthesis.
Results:
The review is expected to identify research gaps that will inform the development of future patient-clinician digital health interventions. We have identified a total of 8333 articles. Screening began in September 2022, and data extraction is expected to commence in February 2023 and end by April 2023. Data analyses and final results will be submitted to a peer-reviewed journal in August 2023.
Conclusions:
We expect to find a wide variety of postcare interventions, some gaps in the quality of research evidence, as well as a lack of detailed information on digital health interventions.
International registered report identifier (irrid):
PRR1-10.2196/42056.
... A well-known barrier to effective physician-patient communication is the use of language and reading levels that are too complex [23]. While the average American reads between a 7th-and 8th-grade level, educational tools like 3D models do not rely heavily on language alone [24,25]. Despite recommendations that patient health information should be delivered at a low readability level, many studies have shown the healthcare system has not done so yet [26]. ...
Background:
Three-dimensional (3D) printing has been increasingly utilized in the healthcare sector for many applications including guiding surgical procedures, creating medical devices, and producing custom prosthetics. As personalized medicine becomes more accessible and desired, 3D printed models emerge as a potential tool in providing patient-specific education. These personalized 3D models are at the intersection of technological innovation and medical education. Our study group utilized a modified Delphi process to create a comprehensive survey tool assessing patient experience with personalized 3D models in preoperative education.
Methods:
A rigorous literature review was conducted of prior patient education survey tools in surgical cases across specialties involving personalized 3D printed models. Through categorization and mapping, a core study team reviewed individual questions, removed duplicates, and edited them into generalizable form. A modified Delphi process was then used to solicit feedback on question clarity and relevance from both 3D printing healthcare experts and patients to create a final survey. Results: 173 survey questions from the literature were evaluated by the core study team, yielding 31 unique questions for further review. After multiple rounds of feedback, a final survey containing 18 questions was developed. Conclusion: 3D printed models have the potential to be helpful tools in surgical patient education, and there exists a need to standardize the assessment of patient experience with these models. This survey provides a standardized, generalizable way to investigate the patient experience with personalized 3D-printed models.
... Studies have shown that for adult and pediatric hospitalized patients, written and visual counseling tools enhanced satisfaction and communication in both patients and providers [25]. Additionally, visual aid or discharge tools enhance comprehension, increase self-care ability, and improve post-discharge impacts among patients [32]. ...
... 15 16 The provision of high-quality teaching and written discharge instructions can be crucial in improving a patient's understanding of their care, facilitating the transition from hospital to home and may prevent avoidable readmissions. [17][18][19][20][21] Engagement in the discharge planning process includes making sure patients and their informal caregivers know the important aspects of their specific health conditions, understand their medications, are able to self-manage common symptoms, have the ability to follow discharge instructions and are informed regarding what signs and symptoms indicate a need to seek appropriate medical care. Despite improvement efforts, there is a need for more efficient approaches to address the barriers patients and their informal caregivers' experience as they transfer through the healthcare system from hospital to geriatric rehabilitation to home. ...
Introduction
Patient–clinician digital health interventions can potentially improve the care of patients with hip fracture transitioning from hospital to rehabilitation to home. Assisting older patients with a hip fracture and their caregivers in managing their postsurgery care is crucial for ensuring the best rehabilitation outcomes. With the increased availability and wide uptake of mobile devices, the use of digital health to better assist patients in their care has become more common. Among the older adult population, hip fractures are a common occurrence and integrated postsurgery care is key for optimal recovery. The overall aims are to examine the available literature on the impact of hip fracture-specific patient–clinician digital health interventions on patient outcomes and healthcare delivery processes; to identify the barriers and enablers to the uptake and implementation of these digital health interventions; and to provide strategies for improved use of digital health technologies.
Methods and analysis
We will conduct a scoping review using Arksey and O’Malley’s methodology framework and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for the Scoping Reviews reporting format. A search strategy will be developed, and key databases will be searched until approximately May 2022. A two-step screening process and data extraction of included studies will be performed by two reviewers. Any disagreement will be resolved by consensus or by a third reviewer. For the included studies, a narrative data synthesis will be conducted. Barriers and enablers identified will be mapped to the domains of the Theoretical Domains Framework and related strategies will be provided to guide the uptake of future patient–clinician digital health interventions.
Ethics and dissemination
This review does not require ethics approval. The results will be presented at a scientific conference and published in a peer-reviewed journal. We will also involve relevant stakeholders to determine appropriate approaches for dissemination.
... This finding may identify persistent gaps in this particular area but may also be a reflection of challenges in care coordination and health systems' access patients' and families' have voiced they face once home [18]. While many interventions aim to help address poor post-discharge outcomes stemming from poor communication such as self-care behaviors or emergency department visits and readmissions [1][2][3], few have evaluated the impact on patient experience [25][26][27][28]. Our paper is one of the first to use Canadian patient experience measures to evaluate its association with the widespread implementation of a novel discharge communication tool. ...
Background
Patient experience when transitioning home from hospital is an important quality metric linked to improved patient outcomes. We evaluated the impact of a hospital-based care transition intervention, patient-oriented discharge summary (PODS), on patient experience across Ontario acute care hospitals.
Methods
We used a repeated cross-sectional study design to compare yearly positive (top-box) responses to four questions centered on discharge communication from the Canadian Patient Experience Survey (2016–2020) among three hospital cohorts with various levels of PODS implementation. Generalized Estimating Equations using a binomial likelihood accounting for site level clustering was used to assess continuous linear time trends among cohorts and cohort differences during the post-implementation period. This research had oversight from a public advisory group of patient and caregiver partners from across the province.
Results
512,288 individual responses were included. Compared to non-implementation hospitals, hospitals with full implementation (>50% discharges) reported higher odds for having discussed the help needed when leaving hospital (OR = 1.18, 95% CI = 1.02–1.37) and having received information in writing about what symptoms to look out for (OR = 1.44, 95% = 1.17–1.78) post-implementation. The linear time trend was also significant when comparing hospitals with full versus no implementation for having received information in writing about what symptoms to look out for (OR = 1.05, 95% CI = 1.01–1.09).
Interpretation
PODS implementation was associated with higher odds of positive patient experience, particularly for questions focused on discharge planning. Further efforts should center on discharge management, specifically: understanding of medications and what to do if worried once home.
... Outside of ICU settings, patient-centered discharge communications (both written and oral) have shown benefit in cardiovascular, maternity and neonatal, and surgical settings. Like the PODS-ICU, discharge communications in other settings have aimed to convey information on next steps (e.g., what to expect), identification and management of risk factors and complications (e.g., when to seek care, pain management), and medications from healthcare providers to patients and their families [46][47][48][49][50][51][52][53][54][55][56][57]. Similarly to the PODS-ICU, many discharge communications from various acute care settings have been reported as time consuming and adding to healthcare provider workload [40,45,57,58]. ...
... Like the PODS-ICU, discharge communications in other settings have aimed to convey information on next steps (e.g., what to expect), identification and management of risk factors and complications (e.g., when to seek care, pain management), and medications from healthcare providers to patients and their families [46][47][48][49][50][51][52][53][54][55][56][57]. Similarly to the PODS-ICU, many discharge communications from various acute care settings have been reported as time consuming and adding to healthcare provider workload [40,45,57,58]. However, they have also been reported to reduce hospital readmissions, improve treatment adherence, and enhance patient satisfaction and can be considered important to successful transitions in care [40,57,58]. ...
... Similarly to the PODS-ICU, many discharge communications from various acute care settings have been reported as time consuming and adding to healthcare provider workload [40,45,57,58]. However, they have also been reported to reduce hospital readmissions, improve treatment adherence, and enhance patient satisfaction and can be considered important to successful transitions in care [40,57,58]. This suggests a high value to improving upon ICU discharge tools (like the PODS-ICU), which could be expected to have cost-savings comparable to discharge communications between hospital and community-based healthcare providers [59]. ...
Background:
Patients leaving the intensive care unit (ICU) often experience gaps in care due to deficiencies in discharge communication, leaving them vulnerable to increased stress, adverse events, readmission to ICU, and death. To facilitate discharge communication, written summaries have been implemented to provide patients and their families with information on medications, activity and diet restrictions, follow-up appointments, symptoms to expect, and who to call if there are questions. While written discharge summaries for patients and their families are utilized frequently in surgical, rehabilitation, and pediatric settings, few have been utilized in ICU settings.
Aim:
To develop an ICU specific patient-oriented discharge summary tool (PODS-ICU), and pilot test the tool to determine acceptability and feasibility.
Methods:
Patient-partners (i.e., individuals with lived experience as an ICU patient or family member of an ICU patient), ICU clinicians (i.e., physicians, nurses), and researchers met to discuss ICU patients' specific informational needs and design the PODS-ICU through several cycles of discussion and iterative revisions. Research team nurses piloted the PODS-ICU with patient and family participants in two ICUs in Calgary, Canada. Follow-up surveys on the PODS-ICU and its impact on discharge were administered to patients, family participants, and ICU nurses.
Results:
Most participants felt that their discharge from the ICU was good or better (n = 13; 87.0%), and some (n = 9; 60.0%) participants reported a good understanding of why the patient was in ICU. Most participants (n = 12; 80.0%) reported that they understood ICU events and impacts on the patient's health. While many patients and family participants indicated the PODS-ICU was informative and useful, ICU nurses reported that the PODS-ICU was "not reasonable" in their daily clinical workflow due to "time constraint".
Conclusion:
The PODS-ICU tool provides patients and their families with essential information as they discharge from the ICU. This tool has the potential to engage and empower patients and their families in ensuring continuity of care beyond ICU discharge. However, the PODS-ICU requires pairing with earlier discharge practices and integration with electronic clinical information systems to fit better into the clinical workflow for ICU nurses. Further refinement and testing of the PODS-ICU tool in diverse critical care settings is needed to better assess its feasibility and its effects on patient health outcomes.
... This is consistent with the literature on patient and carer participation as an important factor in improving care transitions after discharge from the hospital. 45 Several qualitative studies have shown that patient and carer engagement in medication guidance is limited at discharge, and some participants reported wanting to be engaged in medication decisions, including medications that can affect the cognition of the person with dementia. 6 13 Likewise, the tool includes items that evaluated how useful and easy to understand the medication guidance was, unlike other tools. ...
Objective
Medication management guidance for carers of people with dementia at hospital discharge is important to prevent medication-related harm during transitions of care. This study aimed to develop a tool to evaluate medication management guidance provided to carers of people with dementia at hospital discharge.
Design
The tool was developed using mixed methods involving two stages. Stage 1 involved item generation and content validation. Items were based on a previous qualitative study and systematic review. Content validation involved experts and consumers with knowledge or experience of medication management guidance in the acute care setting, and rating each item on importance and relevance. Stage 2 involved conducting cognitive interviews with carers of people with dementia to pretest the tool.
Setting
For stage 1, experts and consumers from Australia, USA and New Zealand were included. For stage 2, carers of people with dementia were recruited across Australia.
Participants
18 experts and consumers participated in round 1 of content validation, and 13 experts and consumers completed round 2. Five carers of people with dementia participated in cognitive interviews.
Results
The final tool contained 30 items capturing information across five domains: (1) provision of medication management guidance at hospital discharge; (2) carer understanding of medication management guidance provided at discharge; (3) carer engagement in discussing the safe use of medications at discharge; (4) carer preparedness to conduct medication management activities after discharge; and (5) co-ordination of medication management guidance after discharge.
Conclusions
We developed the first tool to assess medication management guidance provided for carers of people with dementia at hospital discharge. The tool may be useful to inform future research strategies to improve the delivery of medication management guidance at discharge.
... 40,43 Data on health habits were also collected, including smoking 49 and adherence to diet, exercise and medication. 32,50 Further evaluation included observed symptoms of agitation, 44 knowledge of family planning 35 and patient activation and goal setting. 51 ...
... The effects measured in the reviews were healthcare utilization, 40,50 consultations and opportunity for follow-up, 40 constitutes 'good care'. [22][23][24][25] Our three aspects are included in a previous presentation on ten common important aspects of centredness by Hughes et al., 13 and in the nine themes presented by Håkansson and Eklund. ...
... 40,43 Data on health habits were also collected, including smoking 49 and adherence to diet, exercise and medication. 32,50 Further evaluation included observed symptoms of agitation, 44 knowledge of family planning 35 and patient activation and goal setting. 51 ...
... The effects measured in the reviews were healthcare utilization, 40,50 consultations and opportunity for follow-up, 40 constitutes 'good care'. [22][23][24][25] Our three aspects are included in a previous presentation on ten common important aspects of centredness by Hughes et al., 13 and in the nine themes presented by Håkansson and Eklund. ...
Introduction
The introduction of effective, evidence‐based approaches to centredness in health care is hindered by the fact that research results are not easily accessible. This is partly due to the large volume of publications available and because the field is closely linked to and in some ways encompasses adjoining fields of research, for example, shared decision making and narrative medicine. In an attempt to survey the field of centredness in health care, a systematic overview of reviews was conducted with the purpose of illuminating how centredness in health care is presented in current reviews.
Methods
Searches for relevant reviews were conducted in the databases PubMed, Scopus, Cinahl, PsychINFO, Web of Science and EMBASE using terms connected to centredness in health care. Filters specific to review studies of all types and for inclusion of only English language results as well as a time frame of January 2017–December 2018, were applied.
Results
The search strategy identified 3697 unique reviews, of which 31 were included in the study. The synthesis of the results from the 31 reviews identified three interrelated main themes: Attributes of centredness (what centredness is), Translation from theory into practice (how centredness is done) and Evaluation of effects (possible ways of measuring effects of centredness). Three main attributes of centeredness found were: being unique, being heard and shared responsibility. Aspects involved in translating theory into practice were sufficient prerequisites, strategies for action and tools used in safeguarding practice. Further, a variety and breadth of measures of effects were found in the included reviews.
Conclusions
Our synthesis demonstrates that current synthesized research literature on centredness in health care is broad, as it focuses both on explorations of the conceptual basis and the practice, as well as measures of effects. This study provides an understanding of the commonalities identified in the reviews on centredness in healthcare overall, ranging from theory to practice and from practice to evaluation.
Patient or Public Contribution
Patient representatives were involved during the initiation of the project and in decisions about its focus, although no patient or public representatives made direct contributions to the review process.
