Incorporating Patient Concerns Into Discharge Plans: Evaluation of a Patient-Generated Checklist

Abstract
Background: This paper reports on the effectiveness of a checklist that assists patients to transition safely and sustainably from hospital to home. Methods: Medical wards in three tertiary public hospitals in metropolitan Adelaide provided subjects during 2004. Eligible patients were English-literate and aged at least 60 years, provided written informed consent and had an unplanned hospital admission for a new medical condition. Data was excluded post-hoc if subjects had another hospital readmission for the same condition within seven days of discharge. The study had a quasi-experimental study design in which each hospital acted as its own control. In each hospital, the first half of the study period measured the outcome of usual discharge planning practices (control phase), and the second half of the study period measured the outcome following administration of the checklist (intervention). Quantitative and qualitative (grounded theory) evaluation methods were used. Results: 464 potentially eligible patients were approached and 317 (63.3%) consented to participate (210 control and 107 intervention subjects). Post-hoc exclusion and loss to follow-up reflected 60% (control) and 42% (intervention) subjects. Unplanned readmission to hospital (post hoc exclusion) reflected 21% control and 39% intervention phase subjects. A key reason for loss to follow-up was inability to contact subjects seven days after discharge (29% control, 16% intervention phases). Complete outcome data was collected from 148 subjects. For patients with family/ friends who visited them in hospital, the checklist provided the opportunity for joint discussion and decision-making prior to discharge about daily living activities. These activities were often additional to formal discharge plans. The short duration of hospital admission, and generally poor health precluded many patients without family/ friends from obtaining maximum benefit from the checklist. Conclusion: The checklist improved patients’ preparedness for discharge, particularly when family/ friends were involved.