From discharge to readmission: Understanding the process from the patient perspective

Abstract

BACKGROUND Patient engagement is critical in delivering high‐quality care. However, literature investigating patient perspectives on readmissions is lacking. OBJECTIVES To understand patients' beliefs and attitudes about 30‐day readmissions and to elucidate areas for improvement aimed at reducing readmissions. DESIGN In person survey. SETTING Academic medical center and affiliated community hospital. PATIENTS Patients with 30‐day readmissions to medicine and cardiology services. MEASUREMENTS Patient readiness, attitudes toward readmissions, discharge instructions, ambulatory resources, and follow‐up care. RESULTS Of 479 eligible patients approached for interviews, 230 (48%) were interviewed. Of these, 28% reported not feeling ready for discharge, and this correlated with inadequate symptom resolution, poor pain control, and concerns about self‐care. Sixty‐five percent remembered reviewing discharge paperwork, but over 22% could not identify critical information on this paperwork. Eighty‐five percent reported having a primary doctor; however, only 56% of patients who received a contact number on discharge called a physician before returning to the hospital. One‐third of patients knew where to obtain same‐day care outside of the emergency room. Lastly, patients reported feeling more relieved than burdened upon readmission (7.7 [standard deviation {SD} 2.8) vs 5.9 [SD 3.4]; P < 0.001, scale of 1–10). CONCLUSIONS By engaging readmitted patients we have illuminated areas for future interventions, including better symptom management and self‐care planning before discharge, more clarity in discharge instructions, promoting awareness of outpatient resources, and improved alignment of patient and provider attitudes about readmissions. As the United States strives to reduce readmissions, attending to the patient perspective is critical in informing appropriate avenues for quality improvement. Journal of Hospital Medicine 2016;11:407–412. © 2016 Society of Hospital Medicine

Patients’ readiness for discharge: Predictors and effects on unplanned readmissions, emergency department visits and death

“…However, Howard‐Anderson et al. () found that patients’ readiness for discharge did not differ with respect to the presence of someone to help at home after discharge.…”

“…Studies on readiness for discharge have revealed that it affects patient outcomes such as readmission (Greysen et al., ; Nguyen et al., ; Nylor et al., ; Weiss, Yakusheva, & Bobay, ; Weiss et al., ), mortality (Halm et al., ; Lau et al., ) and emergency department (ED) visits (Bobay, Jerofke, Weiss, & Yakusheva, ; Jack et al., ). Readiness for discharge can be influenced by many factors such as age, sex, socioeconomic status, comorbidity and income (Bobay et al., ; Coffey & McCarthy, ; Howard‐Anderson, Busuttil, Lonowski, Vangala, & Afsar‐Manesh, ; Lau et al., ; Schmocker et al., ; Weiss, Costa, Yakusheva, & Bobay, ; Weiss & Piacentine, ; Weiss et al., ).…”

Predictors of Hospital Readmission in Patients Receiving Outpatient Parenteral Antimicrobial Therapy

“…Many of these issues may be managed as an outpatient, thereby decreasing the need for hospital readmission. Patients' perceptions of the hospital discharge process and 30‐day readmission were evaluated in a recent survey . Of interest, only a third of patients knew where to get same‐day care outside of an emergency department.…”

Assessment of Readability, Understandability, and Completeness of Pediatric Hospital Medicine Discharge Instructions

“…Median age was 3.1 years, and median length of stay was 2.0 days. The median readability score corresponded to a 10th-grade reading level (interquartile range, [8][9][10][11][12]; range, 1-13). Median PEMAT score was 73% (interquartile range, 64%-82%; range, 45%-100%); 36% of instructions scored below 70%, correlating with suboptimal understandability.…”