Careggi Re-Engineered Discharge project: standardize discharge and improve care coordination between healthcare professionals

BACKGROUND: The hospital discharge process plays a key role in patient care. Careggi Re-Engineered Discharge (CaRED) aimed at establishing a meaningful relationship among general practitioners (GPs) and patients, throughout the discharge process. OBJECTIVE: The aim is to describe the activities and results in the period 2014-17 of the CaRED. METHODS: CaRED is a restructured discharge protocol, which foresees a different, more direct form of communication between hospital and GPs, enabled by an ad hoc electronic medical record. The 30-day hospital readmission rate and/or accesses to the emergency department were evaluated as proxy for effective communication. A pre-post survey was launched to assess the GPs' perceived quality, and patient and family satisfaction. RESULTS: A total of 1549 hospitalizations were included, respectively, 717 in the pre and 832 in the post-intervention period. The 30-day hospital readmission rate decreased significantly in the post-intervention period (14.4% vs. 19.4%, χ2(1) = 8.03, P < 0.05).Eighty-two and 52 GPs participated, respectively, in the pre- and post-survey. In the post-phase the percentage of GPs declaring the discharge letter facilitated the communication on the admission causes (χ2(1) = 0.56, P = 0.03) and on what to do if conditions change (χ2(31) = 19.0, P < 0.01) significantly increased, as well as the perception of an easier contact with the hospitalist (χ2(3) = 19.6, P < 0.01).Two-hundred-eighty and 282 patients were enrolled in the pre- and post-survey. The level of understanding of key parts of the discharge letter (reason for hospitalization, post-discharge therapy, follow-up examinations and how to contact the hospital ward) improved significantly (P < 0.01). CONCLUSIONS: CaRED significantly improved the discharge process and became a benchmark for local improvements in communication patterns with GPs.