Planning for safe discharge should optimally begin early in each patient’s stay, and focus on individual patient’s needs. The aims of our study were to, beginning at the start of hospitalization and continuing until discharge, collect patients’ self–reported barriers to discharge, describe the most prevalent barriers, and determine whether barriers were resolved between the first and final surveys.
We content-validated a patient readiness for discharge survey asking about barriers to discharge (such as ability to care for self) by adapting an existing tool, then pretesting refining it among physicians and patients. We then used our tool to carry out daily surveys of random sample of patients admitted to the General Medicine service between October 2013 and April 2014. Each patient was surveyed for the first time on the first or second day of hospitalization, and then followed as frequently as possible until discharge. We then described the frequency with which identified barriers to discharge occurred and compared the rates of resolution of barriers between the first and final surveys using a paired t-test. In addition, a McNemar’s test compared the proportions of patients reporting each barrier on their first and final survey.
163 patients completed on average 1.82 surveys (s.d. 1.10; range 1-8); 83 (51%) patients completed more than one survey. The mean length of stay for the group was 5.42 days (s.d. 11.49) and 44 (27%) were readmitted at 30-days. Patient responses to items on first and final survey before discharge are shown in Figure 1. The most common barriers to discharge on the first survey were unresolved pain (n=50; 60%) and lack of understanding of plan for recovery (n=43; 52%), and the most common barriers to discharge on the final survey remained the same, unresolved pain (n=52; 63%) and lack of understanding of plan for recovery (n=33; 40%). Functional issues also remained a major barrier at both time points. There was no statistically significant reduction in mean number of patient reported barriers to discharge between the admission and final survey (3.12 versus 2.64; p=0.14). Similarly, there were no statistically significant differences in the proportion of patients reporting each barrier between each time point (McNemar’s test p>0.05).
Patient self reported barriers to discharge are common, and in our setting not always completely addressed prior to discharge. These results suggest an important and potentially fruitful opportunity for improved communication and education activities around discharge by engaging with patients directly.