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Handoff Communication Between Hospital and Outpatient Dialysis Units at Patient Discharge: A Qualitative Study

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Background: Hemodialysis patients are vulnerable to adverse events, including those surrounding hospital discharge. Little is known about how dialysis-specific information is shared with outpatient dialysis clinics for discharged patients, and the applicability of existing models of handoff transitions is unknown.

Methods: Semistructured interviews were performed with 36 dialysis care physicians, nurses, and social workers in hospital and outpatient settings. Interviews were transcribed and qualitatively analyzed by trained coders. Intercoder reliability was measured by Cohen's kappa.

Findings: Quality of communication and the actual process were highly variable. Good communication was described as timely, with standardized content, and coordinated between disciplines. A lack of standards, time/workload imbalance, incompatible electronic records between facilities, and unawareness of pending discharge plans were noted barriers to good communication. Poor or absent communication contributes to adverse events, including omission of antibiotics, mismanagement of congestive heart failure, readmissions, and loss of patient trust. Creating explicit standards for communication, fostering accountability, documenting receipt in the outpatient clinic, and continual feedback from outpatient to inpatient settings are methods to facilitate improvement and reduce preventable adverse events.

Conclusions: Standardizing the communication process between inpatient and outpatient dialysis units when patients are discharged from the hospital has potential to reduce adverse events related to poor communication and improve patient care during this transition. Interprofessional collaboration has potential to create robust solutions to this complex problem and foster a culture of multidisciplinary reflexivity.

Document Type: Research Article

Publication date: February 1, 2013

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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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