The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals’ views

Cam, Henrik; Wennlöf, Björn; Gillespie, Ulrika; Franzon, Kristin; Nielsen, Elisabet I.; Ling, Mia; Lindner, Karl-Johan; Kempen, Thomas Gerardus Hendrik; Kälvemark Sporrong, Sofia

doi:10.1186/s12913-023-10192-5

Cited by 4 publications

References 51 publications

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Challenges related to transitioning from hospital to temporary care at a skilled nursing facility: a descriptive study

Ravn-Nielsen,

Bjørk,

Nielsen

et al. 2024

Eur Geriatr Med

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Purpose With decreasing number of hospital beds, more citizens are discharged to temporary care at skilled nursing facilities, requiring increasingly complex care in a non-hospital setting. We mapped challenges related to the transition of citizens from hospital to temporary care at a skilled nursing facility in relation to medication management, responsibility of medical treatment, and communication. Methods Descriptive study of citizens discharged from Odense University Hospital to temporary care from May 2022 to March 2023. Results We included 209 citizens (53% women, median age 81 years). Most citizens (97%; n = 109/112) had their medication changed during hospital admission. Citizens used a median of eight medications, including risk medications (96%, n = 108). Medication-related challenges occurred for 37% (n = 77) of citizens and most often concerned missing alignment of medication records. Half of citizens (47%, n = 99) moved into temporary care with all medication needed for further dispensing. Nurses conducted in median three telephone calls (interquartile range [IQR 1–4]) and sent in median two correspondences (IQR 1–3) per citizen within the first 5 days. Nurses most often called the hospital physician (41% of telephone calls, n = 265/643) and sent correspondences to the general practitioner (55% of correspondences, n = 257/469). For 31% (n = 29/95) of citizens requiring action from nursing staff, this could have been avoided if the nurses had had access to the discharge letter. Conclusion We identified several challenges related to the transition of patients from hospital to temporary care, most often related to medication. A third of actions related to medication management were considered avoidable with improved practices around communication.

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Challenges related to transitioning from hospital to temporary care at a skilled nursing facility: a descriptive study

Ravn-Nielsen,

Bjørk,

Nielsen

et al. 2024

Eur Geriatr Med

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‘You're Just Thinking About Going Home’: Exploring Person‐Centred Medication Communication With Older Patients at Hospital Discharge

Cam,

Franzon,

Sporrong

et al. 2024

Health Expectations

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BackgroundThe hospital discharge process poses significant safety risks for older patients due to complexities in communication and coordination among stakeholders, leading to potential drug‐related problems post‐discharge. Adopting a person‐centred care (PCC) approach in medication communication by healthcare professionals (HCPs) is crucial to ensure positive health outcomes. This study aimed to explore the practice of PCC in medication communication between older patients and HCPs during the hospital discharge process.MethodsWe conducted a qualitative study using non‐participatory direct observations of patient–HCP consultations during hospital discharge, followed by semi‐structured interviews with observed patients and, when applicable, their informal caregivers. Data collection occurred from October 2020 to May 2021 at two Swedish hospitals. We gathered data using an observational form and audio‐recorded all consultations and interviews. The data were analysed thematically using the systematic text condensation method.ResultsTwenty patients were included (median age: 81 years [range: 65–94]; 9 female) in observations and 13 of them participated in interviews. Two patients were accompanied by an informal caregiver during the interviews. Three main themes were identified: (1) The impact of traditional authoritarian structures, depicts power dynamics between patients and their HCPs, showing how traditional structures influence the practice of PCC in medication communication during hospital discharge; (2) Consultation timing and mode not on patients' terms, describes suboptimal times and settings for consultations, along with the use of complex language that hinders effective communication; and (3) Discrepancy in expectations of self‐care ability, illustrates a mismatch between the self‐care guidance provided by HCPs during hospital discharge and the actual needs and preferences of patients and informal caregivers.ConclusionMedication communication between older patients and HCPs during hospital discharge is frequently inconsistent with the practice of PCC. Not only must HCPs improve their communication strategies, but patients and their informal caregivers should also be better prepared for discharge communication and encouraged to participate in their care. This involvement would give them relevant knowledge and tailor communication to their individual needs, preventing problems in managing their medications after discharge.Patient or Public ContributionAn advisory group of six patients and/or informal caregiver contributors provided input on the study design, edited the consent forms, and helped develop the interview guide.

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Continuity of medication information transfer and continuous medication supply during hospital-to-home transitions - nationwide surveys in hospital and community pharmacies after implementing new legal requirements in Germany

Klasing,

Dörje,

Hilgarth

et al. 2024

BMC Health Serv Res

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Background While successful information transfer and seamless medication supply are fundamental to medication safety during hospital-to-home transitions, disruptions are frequently reported. In Germany, new legal requirements came into force in 2017, strengthening medication lists and discharge summaries as preferred means of information transfer. In addition to previous regulations – such as dispensing medication at discharge by hospital pharmacies – hospital physicians were now allowed to issue discharge prescriptions to be supplied by community pharmacies. The aim of this survey study was to gain first nationwide insights into how these requirements are implemented and how they impact the continuity of medication information transfer and continuous medication supply. Methods Two nationwide self-administered online surveys of all hospital and community pharmacies across Germany were developed and conducted from April 17th to June 30th, 2023. Results Overall, 31.0% (n = 111) of all German hospital pharmacies and 4.5% (n = 811) of all community pharmacies participated. The majority of those hospital pharmacies reported that patients who were discharged were typically provided with discharge summaries (89.2%), medication lists (59.5%) and if needed, discharge prescriptions (67.6%) and/or required medication (67.6%). About every second community pharmacy (49.0%) indicated that up to half of the recently discharged patients who came to their pharmacy typically presented medication lists. 34.0% of the community pharmacies stated that they typically received a discharge summary from recently discharged patients at least once per week. About three in four community pharmacies (73.3%) indicated that most discharge prescriptions were dispensed in time. However, one-third (31.0%) estimated that half and more of the patients experienced gaps in medication supply. Community pharmacies reported challenges with the legal requirements – such as patients´ poor comprehensibility of medication lists, medication discrepancies, unmet formal requirements of discharge prescriptions, and poor accessibility of hospital staff in case of queries. In comparison, hospital pharmacies named technical issues, time/personnel resources, and deficits in patient knowledge of medication as difficulties. Conclusion According to the pharmacies´ perceptions, it can be assumed that discontinuation in medication information transfer and lack of medication supply still occur today during hospital-to-home transitions, despite the new legal requirements. Further research is necessary to supplement these results by the perspectives of other healthcare professionals and patients in order to identify efficient strategies.

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The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals’ views

Cited by 4 publications

References 51 publications

Challenges related to transitioning from hospital to temporary care at a skilled nursing facility: a descriptive study

Challenges related to transitioning from hospital to temporary care at a skilled nursing facility: a descriptive study

‘You're Just Thinking About Going Home’: Exploring Person‐Centred Medication Communication With Older Patients at Hospital Discharge

Continuity of medication information transfer and continuous medication supply during hospital-to-home transitions - nationwide surveys in hospital and community pharmacies after implementing new legal requirements in Germany

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