Related Experiment Video
Updated: Nov 4, 2025
The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time
Published on: February 19, 2021
Implementation of a complex intervention to improve hospital discharge: process evaluation of a cluster randomised
Yael Rachamin1, Thomas Grischott2, Stefan Neuner-Jehle2
1Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland yael.rachamin@usz.ch.
Objectives:
To study the implementation of a cluster randomised controlled effectiveness-implementation hybrid trial testing the effectiveness of a medication review at hospital discharge combined with a communication stimulus between hospital physicians (HPs) and general practitioners (GPs) on rehospitalisation of multimorbid older patients.
Design:
Extension of Grant's mixed method process evaluation framework to trials with multilevel clustering.
Setting:
General internal medicine wards in Swiss hospitals.
Participants:
Convenience samples of 15 chief physicians (of 21 hospitals participating in the effectiveness trial), 60 (74) senior HPs, 65 (164) junior HPs and 187 (411) GPs.
Implementation Strategy:
Two-hour teaching sessions for senior HPs on a patient-centred, checklist-guided discharge routine.
Process Evaluation Components:
Data collection on recruitment, delivery and response from chief physicians (semistructured interviews), senior HPs, junior HPs, GPs (surveys) and patients (via HPs). Quantitative data were summarised using descriptive statistics, and interviews analysed using thematic analysis.
Outcome Measures:
Intervention dose (quantitative), implementation fidelity (qualitative), feasibility and acceptability, facilitators and barriers, implementation support strategies.
Results:
Recruitment of hospitals was laborious but successful, with 21 hospitals recruited. Minimal workload and a perceived benefit for the clinic were crucial factors for participation. Intervention dose was high (95% of checklist activities carried out), but intervention fidelity was limited (discharge letters) or unknown (medication review). Recruitment and retention of patients was challenging, partly due to patient characteristics (old, frail) and the COVID-19 pandemic: Only 612 of the anticipated 2100 patients were recruited, and 31% were lost to follow-up within the first month after discharge. The intervention was deemed feasible and helpful by HPs, and the relevance of the topic appreciated by both HPs and GPs.
Conclusions:
The results from this evaluation will support interpretation of the findings of the effectiveness study and may inform researchers and policy makers who aim at improving hospital discharge.
Trial Registration Number:
ISRCTN18427377.
Related Concept Videos
01:31Discharge Summary Forms
Here's a detailed look at the key components and guidelines for preparing a discharge summary:
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:21Planning Nursing Care I
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
01:15Nursing Evaluation
01:24Nursing Process for Patient and Caregiver Teaching II: Planning and Implementation