LEARNING FROM PATIENTS - A DISCHARGE PLANNING IMPROVEMENT PROJECT

Background: In 1991 Beth Israel Hospital (Boston) joined nine other ho spitals in using the Picker/Commonwealth survey instrument to tap pati ent perceptions of their hospitalization experiences. Beth Israel focu sed on one of the nine dimensions of the instrument-continuity and tra nsition (discharge planning). Four work teams: In 1992 four multidisci plinary work teams were formed-for cardiac surgical patients, stroke p atients, patients on a medical unit, and patients on a medical and sur gical unit. Each team conducted a patient/family discussion group, dur ing which recently discharged patients and their families were asked a bout their preparation for discharge and asked for input on how to imp rove the process. Interventions: Each work team developed intervention s on the basis of information specific to their patients. The cardiac work team, for example, developed interdisciplinary practice guideline s for patient care management for the entire postoperative period; the guidelines include a patient education component on what patients and families can expect during hospitalization. Outcomes: Clinicians prac tice differently, inviting more patient feedback and other involvement in care, as a result of their involvement in the project. On the firs t annual patient survey, administered in 1994, only 6% of 1,179 random ly selected patients (versus 20% of the 100 patients first surveyed in 1993) indicated that they did not receive the information they needed to help themselves recover. Current progress and future directions: A standardized teaching packet containing material developed during the discharge planning improvement project is now distributed. In May 199 5 the nursing department launched a patient and family learning center to better meet the health education needs of patients.