The implementation of a comprehensive discharge bundle to improve the discharge process: A quasi-experimental study

摘要

Background: Hospitalised patients are especially vulnerable in times of transitions in care. Structured discharge planning might improve patient outcomes. We implemented and assessed the effect of a multidisciplinary discharge bundle to reduce 30-day readmission. Methods: A pre-post-test design study with a follow-up of one month at four internal medicine wards in a Dutch university teaching hospital. Eligible patients were 18 years and older, acutely admitted and hospitalised for at least 48 hours. The discharge bundle consisted of (1) planning the date of discharge within 48 hours after admission, (2) a discharge checklist, (3) a personalised patient discharge letter, and (4) multidisciplinary patient education. The primary outcome measure was unplanned 30-day readmission. Results: Participants in the post-test group (n = 204) did not have a lower rate of unplanned hospital readmission than those receiving usual care (n = 224) (12.9 vs. 13.2%, p = 0.93). The medical discharge summaries were sent to the general practitioner faster in the post-test period (median of 14 days pre-test vs. 5 days post-test, p < 0.001) and this group also had a trend towards a longer time to first readmission (14 vs. 10 days, p = 0.06). Patient satisfaction was high in both groups (7.5 and 7.4 points, (p = 0.49)). Conclusions: The comprehensive discharge bundle was not effective in reducing the rate of readmission and increasing patient satisfaction, but medical discharge summaries were sent faster to the general practitioner and a trend to a longer time to readmission was present.