Improving handoff communication from hospital to home: the development, implementation and evaluation of a...

To develop, implement and evaluate a personalized patient discharge letter (PPDL) to improve the quality of handoff communication from hospital to home.

From the end of 2006-09 we conducted a quality improvement project; consisting of a before-after evaluation design, and a process evaluation.

Four general internal medicine wards, in a 1024-bed teaching hospital in Amsterdam, the Netherlands.

All consecutive patients of 18 years and older, admitted for at least 48 h.

A PPDL, a plain language handoff communication tool provided to the patient at hospital discharge.

Verbal and written information provision at discharge, feasibility of integrating the PPDL into daily practice, pass rates of PPDLs provided at discharge.

A total of 141 patients participated in the before-after evaluation study. The results from the first phase of quality improvement showed that providing patient with a PPDL increased the number of patients receiving verbal and written information at discharge. Patient satisfaction with the PPDL was 7.3. The level of implementation was low (30%). In the second phase, the level of implementation improved because of incorporating the PPDL into the electronic patient record (EPR) and professional education. An average of 57% of the discharged patients received the PPDL upon discharge. The number of discharge conversations also increased.

Patients and professionals rated the PPDL positively. Key success factors for implementation were: education of interns, residents and staff, standardization of the content of the PPDL, integrating the PPDL into the electronic medical record and hospital-wide policy.