Improving handoff communication from hospital to home: the development, implementation and evaluation of a personalized patient discharge letter

OBJECTIVE: To develop, implement and evaluate a personalized patient discharge letter (PPDL) to improve the quality of handoff communication from hospital to home. DESIGN: From the end of 2006-09 we conducted a quality improvement project; consisting of a before-after evaluation design, and a process evaluation. SETTING: Four general internal medicine wards, in a 1024-bed teaching hospital in Amsterdam, the Netherlands. PARTICIPANTS: All consecutive patients of 18 years and older, admitted for at least 48 h. INTERVENTIONS: A PPDL, a plain language handoff communication tool provided to the patient at hospital discharge. MAIN OUTCOME MEASURES: Verbal and written information provision at discharge, feasibility of integrating the PPDL into daily practice, pass rates of PPDLs provided at discharge. RESULTS: A total of 141 patients participated in the before-after evaluation study. The results from the first phase of quality improvement showed that providing patient with a PPDL increased the number of patients receiving verbal and written information at discharge. Patient satisfaction with the PPDL was 7.3. The level of implementation was low (30%). In the second phase, the level of implementation improved because of incorporating the PPDL into the electronic patient record (EPR) and professional education. An average of 57% of the discharged patients received the PPDL upon discharge. The number of discharge conversations also increased. CONCLUSION: Patients and professionals rated the PPDL positively. Key success factors for implementation were: education of interns, residents and staff, standardization of the content of the PPDL, integrating the PPDL into the electronic medical record and hospital-wide policy.