title: Handoff communication between hospital and outpatient dialysis units at patient discharge: a qualitative study.
abstract: BACKGROUND
  Hemodialysis patients are vulnerable to adverse events, including those surrounding hospital discharge. Little is known about how dialysis-specific information is shared with outpatient dialysis clinics for discharged patients, and the applicability of existing models of handoff transitions is unknown.
  
  
  METHODS
  Semistructured interviews were performed with 36 dialysis care physicians, nurses, and social workers in hospital and outpatient settings. Interviews were transcribed and qualitatively analyzed by trained coders. Intercoder reliability was measured by Cohen's kappa
  
  
  RESULTS
  Quality of communication and the actual process were highly variable. Good communication was described as timely, with standardized content, and coordinated between disciplines. A lack of standards, time/workload imbalance, incompatible electronic records between facilities, and unawareness of pending discharge plans were noted barriers to good communication. Poor or absent communication contributes to adverse events, including omission of antibiotics, mismanagement of congestive heart failure, readmissions, and loss of patient trust. Creating explicit standards for communication, fostering accountability, documenting receipt in the outpatient clinic, and continual feedback from outpatient to inpatient settings are methods to facilitate improvement and reduce preventable adverse events.
  
  
  CONCLUSIONS
  Standardizing the communication process between inpatient and outpatient dialysis units when patients are discharged from the hospital has potential to reduce adverse events related to poor communication and improve patient care during this transition. Interprofessional collaboration has potential to create robust solutions to this complex problem and foster a culture of multidisciplinary reflexivity.
authors: Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. James.Reilly@uphs.upenn.edu
authors: James B
authors: JB
authors: Reilly
authors: Leah M
authors: LM
authors: Marcotte
authors: Jeffrey S
authors: JS
authors: Berns
authors: Judy A
authors: JA
authors: Shea
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D003142:Communication; D003299:Cooperative Behavior; D006282:Health Personnel / Q000458:organization & administration; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D010045:Outpatients; D010351:Patient Discharge / Q000592:standards*; D062209:Patient Handoff / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration; D006435:Renal Dialysis; D012947:Social Work