Challenging the information gap – the patients transfer from hospital to home health care

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Abstract

The purpose of this paper is to identify the information that nurses in hospitals exchange with nurses in home health care (HHC), and what nurses perceive to be the most significant information to exchange. Method: Nurses have an obligation to support and ensure continuity of patient care and to prevent an information gap when patients are transferred from one organizational of health care delivery to another organizational level, for example, from hospital to home health care. In an ongoing prospective study, nurses’ pre-electronic nursing discharge note and their assessment of the information it was necessary to exchange at the same time was audited and analyzed.

The results show variation in the completeness and content of the nursing discharge note. Nurses’ understanding of the scope and content of information to be transmitted varies widely according to the context and the organizational health care level they work within.

The implementation of an electronic nursing discharge note creates the opportunity to identify the accurate information elements that must be documented and exchanged between the nurses to ensure patient safety and inter-organizational continuity of care.

Introduction

The provision of effective and appropriate health care is becoming more and more complex and complicated [1], [2]; challenges include the frequent, rapid changes in the patterns of health service delivery and the changing demographics of the people served. The patient population is increasingly elderly; more people are suffering from chronic illness, yet the length of hospital stay is decreasing, and an increasing proportion of health care is provided as out patient care and/or in community health care [3], [4]. Many patients will experience one or more transitions between care providers during the trajectory of their illness. Continuity of patient care is regarded as a key component in ensuring safe and quality care for patients across all health care delivery level transitions [5]. The modernization of health care has, however, resulted in fragmentation, discontinuity in care and differentiation of health care organizations and professions [6]. Hospital and the community health care system appear to have different and conflicting values and objectives [6], [7], [8]. At the same time the health care authorities [9], [10], [11], look to the providers and the patients themselves for development and enhancement of continuity of patient care in the health care [12], [13], [14], [15], [16]. The fragmentation and conflicts can become a threat to patient safety and a barrier to enhancing and developing a system of appropriate patient care across different organizational levels. Patients have reported experiencing gaps and discontinuity in their health care, especially in transitions from hospital to HHC [17].

It is expected that the advent and implementation of the electronic patient record (EPR) in general, and specifically, electronic discharge summary, will simplify the exchange of information between agencies and improve the quality and continuity of care [9], [18], [19]. The nursing discharge note has been identified as a significant component of the EPR [20]. The purpose of a discharge note is to exchange information between health care providers in hospital and community health care, as well as to be a tool that will contribute to inter-organizational continuity of care and compensate for fragmented health care [21].

Information technology (IT) provides the capability to capture, store, and handle vast amounts of information. Hannah [22] emphasizes that the nursing profession has to address the essential data needs of nurses in all practice settings. So a key question arises: what is the scope, level of detail, and accuracy of information to be exchanged that contributes to the provision of effective and appropriate inter-organizational continuity of care for patients who need follow-up health care after their discharge from the hospital.

Section snippets

The aim

The data used for this paper is a subset of a larger ongoing pretest-posttest prospective study. The data and analysis presented here is from the pretest. The aim of this paper is to identify (1) the information nurses in hospital exchange with the nurses in home health care (HHC) and (2) what nurses perceive to be the most appropriate/relevant information to exchange.

Challenges in nurses’ information exchange

There are two main objectives for focusing on nurses’ exchange of information: compliance with health-care legislation [23], [24], and safety in health care and nursing practice for the patient [25].

Methods

The overall study design uses a pretest–posttest where the intervention entails implementation of an EPR at a large university hospital in Norway’s capital, Oslo, without the involvement of the researchers. The health districts receiving patients discharged from this hospital are also included in the study.

Ethical considerations

The regional ethical committee for medical research and the Norwegian science data services approved the project. All unique personal identifying information about the patients in the copy of the nursing discharge notes was eliminated to ensure each patient’s anonymity. The questionnaire was distributed from a contact person from each hospital unit and districts, and no identification or lists from the participating nurses were available to the researchers.

Analysis

The two sections in the nursing discharge note were analyzed separately. The 23 items specified in section one (Fig. 1a) were coded and summed up in relation to the amount and completeness of the information provided. Section two (Fig. 1b), the summary, was analyzed in two phases, comprising both a deductive and an inductive content analysis approach. The deductive and first auditing phase focused on the summary’s formal structure. The second auditing and inductive phase analyzed the content of

Findings

The findings will be presented in two sections, first from the analysis of the nursing discharge notes and then from the nurses’ perspective on the information to be exchanged as found in the questionnaire.

Discussion

The discussion will follow two axes. First, the nurses accessibility of patient information and secondly the appropriateness of the content of the exchanged information will be discussed. We will compare the findings on the content of the nursing discharge note with the four content points recommended and described above [41] and consider how the existing information content corresponds with the nurses assessment of what is the most important information to deliver and receive.

Limitations

The study has some limitations. First, the nursing discharge notes that were audited were not collected from all of the units at the hospital, but only at the units included in the study. Second, it was found that only 21 of 36 patients who were referred to the HHC had a discharge note. The conclusion that there were no exchanges of information about the 15 patients who lacked a discharge note must be interpreted carefully. Whether other information was supplied or papers went missing during

Conclusion

This paper’s objective was to identify the information that nurses in hospitals exchange with nurses in HHC and what nurses perceive to be the most appropriate information to exchange. The findings showed that both accessibility to information and the completeness, amount and content of the exchanged information varied in the nursing discharge notes that were studied. It also became evident that nurses in hospital and in the HHC have different perceptions about the most important information to

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