Weetman, Katherine, Wong, Geoffrey, Scott, Emma, MacKenzie, Eilidh, Schnurr, Stephanie and Dale, Jeremy (2019) Improving best practice for patients receiving hospital discharge letters : a realist review. BMJ Open, 9 (6). e027588. doi:10.1136/bmjopen-2018-027588 ISSN 2044-6055.
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Abstract
Objective
To understand how different outcomes are achieved from adult patients receiving hospital discharge letters from inpatient and outpatient settings.
Design
Realist review conducted in six main steps: (1) development of initial theory, (2) searching, (3) screening and selection, (4) data extraction and analysis, (5) data synthesis and (6) programme theory (PT) refinement.
Eligibility criteria
Documents reporting evidence that met criteria for relevance to the PT. Documents relating solely to mental health or children aged <18 years were excluded.
Analysis
Data were extracted and analysed using a realist logic of analysis. Texts were coded for concepts relating to context, mechanism, outcome configurations (CMOCs) for the intervention of patients receiving discharge letters. All outcomes were considered. Based on evidence and our judgement, CMOCs were labelled ‘positive’ or ‘negative’ in order to clearly distinguish between contexts where the intervention does and does not work.
Results
3113 documents were screened and 103 were included. Stakeholders contributed to refining the PT in step 6. The final PT included 48 CMOCs for how outcomes are affected by patients receiving discharge letters. ‘Patient choice’ emerged as a key influencer to the success (or not) of the intervention. Important contexts were identified for both ‘positive’ CMOCs (eg, no new information in letter) and ‘negative’ CMOCs (eg, letter sent without verifying patient contact details). Two key findings were that patient understanding is possibly greater than clinicians perceive, and that patients tend to express strong preference for receiving letters. Clinician concerns emerged as a barrier to wider sharing of discharge letters with patients, which may need to be addressed through organisational policies and direction.
Conclusions
This review forms a starting point for explaining outcomes associated with whether or not patients receive discharge letters. It suggests several ways in which current processes might be modified to support improved practice and patient experience.
| Item Type: | Journal Article |
|---|---|
| Subjects: | P Language and Literature > P Philology. Linguistics R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Divisions: | Faculty of Social Sciences > Centre for Applied Linguistics Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
| Library of Congress Subject Headings (LCSH): | Patient discharge instructions -- Research, Hospitals -- Admission and discharge |
| Journal or Publication Title: | BMJ Open |
| ISSN: | 2044-6055 |
| Official Date: | 9 June 2019 |
| Dates: | Date Event 9 June 2019 Published 9 June 2019 Available 15 May 2019 Accepted 30 October 2018 Submitted |
| Volume: | 9 |
| Number: | 6 |
| Article Number: | e027588 |
| DOI: | 10.1136/bmjopen-2018-027588 |
| Status: | Peer Reviewed |
| Publication Status: | Published |
| Access rights to Published version: | Open Access (Creative Commons open licence) |
| Date of first compliant deposit: | 12 June 2019 |
| Date of first compliant Open Access: | 12 June 2019 |
| RIOXX Funder/Project Grant: | Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Clinical Commissioning Groups (CCGs) of Coventry and Rugby and South Warwickshire UNSPECIFIED |
| URI: | https://wrap.warwick.ac.uk/118330/ |
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