“It's like two worlds apart”: an analysis of vulnerable patient handover practices at discharge from hospital
- 1Faculty of Health and Social Care, London South Bank University, London, UK
- 2Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- 3Universitat Autònoma de Barcelona, Barcelona, Spain
- 4Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), Spain
- 5University of Utrecht, Utrecht, The Netherlands
- 6University of Stavanger, Stavanger, Norway
- 7Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Correspondence to Raluca Oana Groene, Faculty of Health and Social Care, London South Bank University, Keyworth Street, K2 Building, London SE1 6NG, UK;
- Accepted 24 September 2012
- Published Online First 30 October 2012
Background Handover practices at hospital discharge are relatively under-researched, particularly as regards the specific risks and additional requirements for handovers involving vulnerable patients with limited language, cognitive and social resources.
Objective To explore handover practices at discharge and to focus on the patients’ role in handovers and on the potential additional risks for vulnerable patients.
Methods We conducted qualitative interviews with patients, hospital professionals and primary care professionals in two hospitals and their associated primary care centres in Catalonia, Spain.
Results We identified handover practices at discharge that potentially put patients at risk. Patients did not feel empowered in the handover but were expected to transfer information between care providers. Professionals identified lack of medication reconciliation at discharge, loss of discharge information, and absence of plans for follow-up care in the community as quality and safety problems for discharge handovers. These occurred for all patients, but appeared to be more frequent and have a greater negative effect in patients with limited language comprehension and/or lack of family and social support systems.
Conclusions Discharge handovers are often haphazard. Healthcare professionals do not consider current handover practices safe, with patients expected to transfer information without being empowered to understand and act on it. This can lead to misinformation, omission or duplication of tests or interventions and, potentially, patient harm. Vulnerable patients may be at greater risk given their limited language, cognitive and social resources. Patient safety at discharge could benefit from strategies to enhance patient education and promote empowerment.
- Patient safety
- Adverse events, epidemiology and detection
- Clinical microsystem
- Patient education
- Qualitative research
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