Enhancing medicine information handover at hospital discharge: Evaluation of a multifaceted intervention pilot trial

Hospital pharmacists and doctors should collaborate to prepare discharge medicine handover information and pharmacists and nurses in providing discharge medicine counselling. This pilot trial evaluated a multifaceted intervention that included training hospital doctors to record medicine changes, patient risk stratification, and collaborative doctor and pharmacist discharge medicine reconciliation to improve information handover.

A pilot study was undertaken at two hospitals in Queensland, Australia. Evaluation incorporated an audit of intervention patient discharge medicine information handover with a control cohort and a time-and-motion observation. Eligible general medicine patients ≥65 years were recruited over nine weeks; a randomisation process was followed to select the control group. We aimed to incorporate 50 intervention patient discharges in the audit.

Most of the 52 intervention and 50 control patients were male (34/52, 65.5 %; 32/50, 64.0 %); average age was 78.6 (SD = 9.0) and 77.7 (SD = 9.3) years. Medicine reconciliation was completed at the time of discharge for 50/52 (96.2 %) of intervention and 34/50 (68.0 %) of control patients; more electronic discharge summaries of intervention patients included all medicines compared to control patients; pharmacists were involved in all intervention discharges compared to 90.0 % (45/50) of control discharges. Discharge summaries of intervention patients were sent to general practitioners within 4.3 days and 9.2 days for control patients. Time-and-motion observations showed that pharmacist discharge medicine information handover time was reduced by 32 min between intervention and control cohorts.

Our study showed that the multifaceted intervention reduced the time required to complete discharge medicine handover information, facilitated patient discharge, and reduced the time-period of sending discharge summaries to general practitioners.