244 - The Effects of a Standardized Discharge Process on Quality and Satisfaction of Care

An effective discharge is a vital component of high-quality and equitable patient care. To achieve this, the discharge process should go beyond just providing written and verbal information regarding the care received, treatment plan, and expectations going forward. Often the essential discharge components can be omitted due to a lack of formal training, time, and language barriers. 


Objective:

We sought to determine how a formal, standardized discharge process would affect the quality of care delivered and patient/family satisfaction.


Design/Methods:

This was a prospective observational pre/post-intervention study at a freestanding Children’s Hospital Minor Care department done by convenience sampling of a total of 370 encounters. Using previous studies as a model we utilized a criterion for a complete discharge using the DC HOME mnemonic with some additions (DC HOME+). This included diagnosis, care rendered, health/anticipatory guidance, obstacles/barriers, medications, expectations, open-ended or teach-back communication, and for limited English proficient (LEP) patients, interpretation, written discharge instructions, and prescription dosing in patient’s target language. Providers were observed prior to implementing DC HOME+ to determine if they addressed each discharge component. Families were then surveyed on their perception of the components addressed and their overall level of satisfaction of provided teaching/instruction. Providers then underwent formal training and post-intervention observations were completed and scored in the same way. Discharge quality was categorized as low, medium, or high based on the number of components addressed and patient satisfaction.


Results:

Use of DC HOME+ resulted in a 59% increase in high-quality provider-observed discharges. Three components with a statistically significant improvement were health/anticipatory guidance from 95.7% to 99.5% (p=0.037), obstacles from 6.5% to 61.1% (p< 0.001), and incorporation of the open-ended/teach-back communication from 18.4% to 73% (p< 0.001). Surveys showed a 69.2% increase in high-quality discharges.  The inclusion of the obstacle component improved from 48.1% to 73.5% (p< 0.001). Families who reported feeling very satisfied increased from 62%to 79% (p< 0.001).


Conclusion(s):

Implementation of a standardized discharge process and open-ended/teach-back verbal communication limited discharge component omissions, enabled consistency, and improved comprehension. The use of a standardized DC HOME+ model led to a significant increase in high-quality and equitable discharges and improved patient satisfaction.