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Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers
  1. Gijs Hesselink1,
  2. Maria Flink2,3,
  3. Mariann Olsson2,3,
  4. Paul Barach4,5,6,
  5. Ewa Dudzik-Urbaniak7,
  6. Carola Orrego8,
  7. Giulio Toccafondi9,
  8. Cor Kalkman4,
  9. Julie K Johnson10,
  10. Lisette Schoonhoven1,11,
  11. Myrra Vernooij-Dassen1,12,13,
  12. Hub Wollersheim1,
  13. on behalf of the European HANDOVER Research Collaborative
  1. 1Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. 2Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
  4. 4Patient Safety Center, University Medical Center Utrecht, Utrecht, The Netherlands
  5. 5Department of Health Studies, University of Stavanger, Stavanger, Norway
  6. 6School of Medicine, University College Cork, Cork, Ireland
  7. 7National Center for Quality Assessment in Health Care, Krakow, Poland
  8. 8Avedis Donabedian Institute, Universidad Autónoma de Barcelona and CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
  9. 9Clinical Risk Management and Patient Safety Centre, GRC, Tuscany Region, Florence FI, Italy
  10. 10Centre for Clinical Governance Research in Health, University of New South Wales, Sydney, New South Wales, Australia
  11. 11Faculty of Health Sciences, University of Southampton, Southampton, UK
  12. 12Department of Primary Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  13. 13Kalorama Foundation, Nijmegen, The Netherlands
  1. Correspondence to Gijs Hesselink, Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 114 IQ healthcare, Nijmegen 6500 HB, The Netherlands; G.Hesselink{at}


Background Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients.

Objective The aim of the paper is to explore the barriers and facilitators to patient-centred care in the hospital discharge process.

Methods A qualitative study using purposive sampling of 192 individual interviews and 26 focus group interviews was conducted in five European Union countries with patients and/or family members, hospital physicians and nurses, and community general practitioners and nurses. A modified Grounded Theory approach was used to analyse the data.

Results The barriers and facilitators were classified into 15 categories from which four themes emerged: (1) healthcare providers do not sufficiently prioritise discharge consultations with patients and family members due to time restraints and competing care obligations; (2) discharge communication varied from instructing patients and family members to shared decision-making; (3) patients often feel unprepared for discharge, and postdischarge care is not tailored to individual patient needs and preferences; and (4) pressure on available hospital beds and community resources affect the discharge process.

Conclusions Our findings suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients’ and families’ capabilities, needs and preferences. Future interventions should be directed at healthcare providers’ attitudes and their organisation's leadership, with a focus on improving communication among care providers, patients and families, and between hospital and community care providers.

  • Attitudes
  • Qualitative research
  • Hand-off
  • Transitions in care

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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