Who is responsible for a safe discharge from hospital? A prospective risk analysis in the German setting

A representative national survey on risk management in German hospitals has recently identified hospital discharge as a key area of attention. Based on the consensus in the literature about the need to address patient safety at system level, this paper does not only look at the processes of discharge designed by single hospitals, but also takes account of the broader legal and regulatory framework.

Failure Mode and Effects Analysis (FMEA) was applied for risk identification and assessment. For the analysis of the current status in hospitals, three hospitals were interviewed about their discharge processes. For the system perspective, the legislative and self-administrative framework specific for the German setting was reviewed.

The FMEA allowed the identification of a number of actions for risk control in the responsibility of the hospitals and within the framework. Some risks are mainly caused by the legal framework, whereas others can only be addressed by the hospitals themselves. The continuity of drug treatment and the lack of back-up systems after discharge were identified as posing relevant risks to patient safety.

Rich interaction was found between the hospitals and the framework they work in impacting patient safety at hospital discharge. The contribution of the legal and regulatory framework to patient safety needs to be taken into account more actively by policy makers in the future.