Background: Discharge planning should begin at the time of admission and, among its many purposes, involves preparing patients for the transition out of the hospital. Unfortunately, many hospitalized patients do not understand or agree with their provider about their discharge plan, including the timing and location of dismissal. When patients and their providers do not engage in successful discharge planning, patients may feel unprepared for dismissal, which may have negative downstream consequences, such as increased readmission risk or length of stay. Our goal was to measure the relationships between patient-provider communication regarding discharge planning following ward rounds and a validated patient readiness for discharge assessment.
Methods: A prospective, observational study of hospitalized patients on inpatient medicine 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 (HD) 3 regarding three domains of discharge planning; 1) was discharge planning was discussed? 2) anticipated discharge date 3) anticipated discharge location. Patient-provider agreement (agree vs. not-agree) regarding for each domain of discharge planning was assessed. Patients also completed the Short-Form Readiness for Hospital Discharge Scale (RHDS) scored from 0-80 with 80 being most ready for discharge. Then associations between discharge agreement and RHDS scores were analyzed using independent 2-sample t-tests.
Results: Complete data sets were available for 83 patients, the majority of whom were male (n=46, 55.4%), discharged to home (n=57, 68.7%) with an average (median [IQR]) age of 68 [56-80] and length of stay of 4 days [3-7]. On HD #3, 40 patients (48.2%) reported having discussed discharge plans with their provider, 48 patients (57.8%) agreed with their provider regarding discharge date and 59 (71.1%) agreed regarding discharge location. There were no significant associations between patient RHDS scores (mean [SD]) and patients reporting they had discussed discharge plans with their physician team (yes: 52.8 [10.2] vs. no: 53.5 [13.6], p=0.38), patient-physician agreement about discharge date (agree: 54.7 [11.9] vs. disagree: 52.0 [11.8], p=0.16) or discharge location (agree: 52.8 [12.5] vs. disagree: 55.5 [11.3], p=0.18).
Conclusions: Patients and their providers frequently disagree about key aspects of discharge planning. However, we found no association between discharge agreement and RHDS scores, suggesting that successfully preparing a patient for discharge involves more than communication about the date and location of dismissal. Future research should explore how other aspects of patient-provider communication influence discharge readiness and other outcomes, such as 30-day readmission.