Hospital discharge is a critical transition in care, yet recent data show much room for improvement: 1 in 5 patients experiences an adverse event or readmission within 30 days of discharge. Presently, metrics for the quality of discharge care are limited, and little is known about factors affecting the quality of hospital discharge from the perspective of physicians. Residents’ perceptions are particularly important given their unique viewpoint of the discharge process as trainees and their role as primary care givers at teaching hospitals, which collectively provide 20% of all hospital care in the United States.
We employed qualitative methods to describe the discharge process from the resident's perspective and generate hypotheses about quality‐limiting factors and key strategies for improvement through in‐depth in‐person interviews. We developed a purposeful sample of participants with attention to postgraduate year and experience in different hospital settings. Our study design included 2 internal medicine training programs—Yale and New York University (NYU)— to ensure a wide breadth of experiences. To date, we have completed 17 interviews with Yale residents and have begun enrollment at NYU. Interviews were professionally transcribed and independently coded by 2 investigators, and discrepancies were resolved by consensus. Thematic analysis was performed by a diverse research team using the constant comparative method.
We have analyzed interviews with 17 Yale residents to date: 10 (59%) were seniors (PGY‐2 or PGY‐3), 7 were interns (41%), and 10 were female (59%). Based on these interviews, we have identified 5 unifying themes representing factors perceived to limit the quality of discharge care: (1) competing priorities of timely versus thorough discharge, (2) lack of communication between discharge team members, (3) uncertainty about provider roles and patient readiness for discharge, (4) lack of standardization in discharge procedures, and (5) poor patient communication and postdischarge feedback. Representative excerpts from interview transcripts will be presented to illustrate conceptual variations of these quality‐limiting factors as well as to support the overall consistency and robustness of each theme above.
Quality‐limiting factors identified by residents may generate hypotheses to develop novel quantitative measures of quality that are grounded in the experiences of physicians providing discharge care. Residents’ insights on this topic may also help shape training and practice to improve the quality of discharge care at teaching hospitals.
S. R. Greysen ‐ none; D. Schiliro ‐ none; L. I. Horwitz ‐ none; L. A. Curry ‐ none; M. Radford ‐ none; E. H. Bradley ‐ none
To cite this abstract:Greysen S, Schiliro D, Horwitz L, Curry L, Radford M, Bradley E. Residents’ Perceptions of Factors Limiting the Quality of Hospital Discharge. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 51. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/residents-perceptions-of-factors-limiting-the-quality-of-hospital-discharge/. Accessed March 28, 2020.