Background: Discharge planning should begin at the time of admission and involve preparing patients for the transition out of the hospital. Unfortunately, many hospitalized patients disagree with their provider about their discharge plan, including what needs to be accomplished in the hospital or the dismissal’s timing and location. When patients and their providers do not engage in successful discharge planning, patients may feel unprepared for dismissal, potentially leading to discharge delays. Our goal was to measure the relationships between patient-provider communication regarding discharge planning following ward rounds and delayed discharge.
Methods: A prospective, observational study of hospitalized patients on inpatient medical services at Mayo Clinic Hospital. Patients and their primary providers (resident, advanced practice provider, or attending) were independently surveyed following ward rounds on hospital day #3 regarding several essential care items, including the following aspects of dismissal planning; 1) what needs to be accomplished before you/your patient leave the hospital? 2) anticipated discharge date 3) anticipated discharge location (e.g., home, skilled nursing facility). Patient-provider agreement (agree vs. not-agree) regarding each domain of discharge planning was assessed. Delayed discharge (yes/no), defined as a patient discharged after being recorded as medically stable for discharge by the healthcare team in the electronic health record, was also measured. Associations between dismissal agreement and delayed discharge were analyzed using bivariate logistic regression.
Results: Complete data sets were available for 439 patients. The majority of whom were male (n=236, 54%), discharged to home (n=303, 69%) with an average (median [IQR]) age of 68 [58-80] and length of stay of 5 days [4-8]. On HD #3, 75 patients (17 %) agreed with their provider about what needs to be accomplished before dismissal, 169 patients (39 %) agreed with their provider regarding discharge date, and 312 (71 %) agreed regarding discharge location.In the bivariate models, the odds of delayed discharge was significantly associated with patient-provider disagreement regarding 1) what needs to be accomplished before dismissal (OR [95% CI], 2.60 [1.01-6.72]; p=0.049), 2) anticipated discharge date (2.16 [1.17-4.01; p=0.01), and discharge location (3.17 [1.83-5.49]; p<0.0001).
Conclusions: Patients and their providers frequently disagree about crucial aspects of dismissal planning, which, in turn, is associated with significantly increased odds of delayed discharge. These findings demonstrate the critical need for effective communication regarding discharge planning early in the patient’s hospital stay. Future research should identify interventions to promote shared mental models of planning between patients and their providers.