Improving patient discharge and reducing hospital

Improving patient discharge and reducing hospital readmissions by using Intervention Mapping Gijs Hesselink1*, Marieke Zegers1, Myrra Vernooij-Dassen1,2,3, Paul Barach4,5,6, Cor Kalkman4, Maria Flink7,8, Gunnar Öhlén9,10, Mariann Olsson7,8, Susanne Bergenbrant11, Carola Orrego12, Rosa Suñol12, Giulio Toccafondi13, Francesco Venneri13, Ewa Dudzik-Urbaniak14, Basia Kutryba14, Lisette Schoonhoven1, Hub Wollersheim1

and on behalf of the European HANDOVER Research Collaborative


Background: There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge.

Methods: The Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance.Improving patient discharge and reducing hospital

Results: Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well- coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change.

Conclusions: This study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.

Keywords: Patient handoff, Patient discharge, Patient readmission, Intervention mapping, Adverse events

* Correspondence: 1Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), 114 IQ healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands Full list of author information is available at the end of the article

© 2014 Hesselink et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.


Hesselink et al. BMC Health Services Research 2014, 1

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