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Improved communication in post-ICU care by improving writing of ICU discharge letters: a longitudinal before‐after study
  1. Stephanie Medlock1,
  2. Saeid Eslami1,
  3. Marjan Askari1,
  4. Erik Jan van Lieshout2,
  5. Dave A Dongelmans2,
  6. Ameen Abu-Hanna1
  1. 1Department of Medical Informatics, University of Amsterdam Academic Medical Centre, Amsterdam, The Netherlands
  2. 2Department of Intensive Care Medicine, University of Amsterdam Academic Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Stephanie Medlock, Department of Medical Informatics, University of Amsterdam Academic Medical Centre, Meibergdreef 15, AZ Amsterdam 1105, The Netherlands; s.k.medlock{at}amc.uva.nl

Abstract

Background The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the timeliness of discharge letters.

Methods A management directive was operationalised by a working group of ICU staff in a longitudinal before–after study. The intervention consisted of (a) changing policy to require a letter for use as a transfer note at the time of ICU discharge, (b) changing the assignment of responsibility to an automatic process, (c) leveraging positive peer pressure by making the list of patients in need of letters visible to colleagues and (d) provision of decision support, through automatic copying of important content from the patient record to the letter and email reminders if letters were not written on time. Statistical process control charts were used to monitor the longitudinal effect of the intervention.

Results The intervention resulted in a 77.9% absolute improvement in the proportion of patients with a complete transfer note at the time of discharge, and an 85.2% absolute improvement in the number of discharge letters written. Statistical process control shows that the effect was sustained over time.

Conclusions A multifaceted intervention can be highly effective for improving discharge communication from the ICU.

  • Quality improvement
  • decision support systems
  • clinical
  • hand-off
  • medication reconciliation
  • critical care
  • clinical decision support
  • handover
  • intensive care
  • decision support
  • clinical
  • decision support
  • computerised
  • information technology
  • evidence-based medicine
  • healthcare quality improvement
  • patient safety
  • diagnostic errors

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Footnotes

  • Funding This study was funded in part by The Netherlands Organization for Health Research and Development (ZonMw), through the ICOVE project (#311020302).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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