title: Improving the discharge process by embedding a discharge facilitator in a resident team.
abstract: BACKGROUND
  Hospital discharges are vulnerable periods for patient safety, especially in teaching hospitals where discharges are done by residents with competing demands. We sought to assess whether embedding a nurse practitioner on a medical team to help physicians with the discharge process would improve communication, patient follow-up, and hospital reutilization.
  
  
  METHODS
  A 5-month randomized controlled trial was conducted on the medical service at an academic tertiary-care hospital. A nurse practitioner was randomly assigned to 1 resident team to complete discharge paperwork, arrange follow-up appointments and prescriptions, communicate discharge plans with nursing and primary care physicians, and answer questions from discharged patients.
  
  
  RESULTS
  Intervention patients had more discharge summaries completed within 24 hours (67% vs. 47%, P < 0.001). Similarly, they had more follow-up appointments scheduled by the time of discharge (62% vs. 36%, P < 0.0001) and attended those appointments more often within 2 weeks (36% vs. 23%, P < 0.0002). Intervention patients knew whom to call with questions (95% vs. 85%, P = 0.003) and were more satisfied with the discharge process (97% vs. 76%, P < 0.0001). Attending rounds on the intervention team finished on time (45% vs. 31%, P = 0.058), and residents signed out on average 46 minutes earlier each day. There was no significant difference between the groups in 30-day emergency department visits or readmissions.
  
  
  CONCLUSIONS
  Helping resident physicians with the discharge process improves many aspects of discharge communication and patient follow-up, and saves residents' time, but had no effect on hospital reutilization for a general medicine population.
authors: Massachusetts General Hospital, Department of Medicine, Boston, Massachusetts 02114, USA. Kfinn@partners.org
authors: Kathleen M
authors: KM
authors: Finn
authors: Rebecca
authors: R
authors: Heffner
authors: Yuchiao
authors: Y
authors: Chang
authors: Hasan
authors: H
authors: Bazari
authors: Daniel
authors: D
authors: Hunt
authors: Karen
authors: K
authors: Pickell
authors: Rhodes
authors: R
authors: Berube
authors: Shveta
authors: S
authors: Raju
authors: Elizabeth
authors: E
authors: Farrell
authors: Christiana
authors: C
authors: Iyasere
authors: Ryan
authors: R
authors: Thompson
authors: Terrence
authors: T
authors: O'Malley
authors: Walter
authors: W
authors: O'Donnell
authors: Andrew
authors: A
authors: Karson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D012111:Residence Characteristics; D013223:Statistics as Topic; D013997:Time Factors; D014481:United States; D055815:Young Adult