title: Improved communication in post-ICU care by improving writing of ICU discharge letters: a longitudinal before-after study.
abstract: BACKGROUND
  The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the timeliness of discharge letters.
  
  
  METHODS
  A management directive was operationalised by a working group of ICU staff in a longitudinal before-after study. The intervention consisted of (a) changing policy to require a letter for use as a transfer note at the time of ICU discharge, (b) changing the assignment of responsibility to an automatic process, (c) leveraging positive peer pressure by making the list of patients in need of letters visible to colleagues and (d) provision of decision support, through automatic copying of important content from the patient record to the letter and email reminders if letters were not written on time. Statistical process control charts were used to monitor the longitudinal effect of the intervention.
  
  
  RESULTS
  The intervention resulted in a 77.9% absolute improvement in the proportion of patients with a complete transfer note at the time of discharge, and an 85.2% absolute improvement in the number of discharge letters written. Statistical process control shows that the effect was sustained over time.
  
  
  CONCLUSIONS
  A multifaceted intervention can be highly effective for improving discharge communication from the ICU.
authors.affiliation: Department of Medical Informatics, University of Amsterdam Academic Medical Centre, Meibergdreef 15, Amsterdam, The Netherlands. s.k.medlock@amc.uva.nl
authors.forename: Stephanie
authors.initials: S
authors.lastname: Medlock
authors.forename: Saeid
authors.initials: S
authors.lastname: Eslami
authors.forename: Marjan
authors.initials: M
authors.lastname: Askari
authors.forename: Erik Jan
authors.initials: EJ
authors.lastname: van Lieshout
authors.forename: Dave A
authors.initials: DA
authors.lastname: Dongelmans
authors.forename: Ameen
authors.initials: A
authors.lastname: Abu-Hanna
mesh_terms: D000368:Aged; D003142:Communication; D006801:Humans; D007362:Intensive Care Units; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010351:Patient Discharge; D011785:Quality Assurance, Health Care; D014956:Writing