Improving the process of hospital discharge for medical patients

A combination of methods was used in the development of the discharge intervention for patients on medical wards, these included: (1) Patient interviews and professional focus groups which explored barriers to a successful discharge; (2) A systematic review of comprehensive discharge protocols examined the effects of standardising discharge practices; (3) Reviews of patient education methods informed the intervention's components; (4) Patient and professional surveys explored perspectives, perceptions of information needs and current practices which influenced the intervention's content and design. A pilot study tested the usability and acceptability of an educational intervention in hospital and the community. The facilitated intervention (computer presentation and booklet) was designed to give patients confidence to participate and ask questions about their discharge. Patient outcome measures included knowledge, SF36, a validated patient diary and self-efficacy questionnaire. Barriers to a successful discharge included lack of knowledge, poor communication and co-ordination of discharge and no clear definition of professionals' roles. The systematic review of discharge planning protocols showed no significant improvements in patient outcomes. Patient and professional questionnaires highlighted a lack of written information and patients identified the need for specific information, with greater importance placed on information post-discharge. The patient education intervention was piloted with 50 patients, 48 understood their diagnosis and 46 could explain their medication. Significant differences were found in the SF36 (pain, social functioning and activities) and the self-efficacy questionnaire (between discharge and one month post discharge). Patients found the intervention usable and reported increased confidence to ask questions. A definitive randomised controlled trial is required to establish the effect of the education package on patient outcomes.