title: Which reasons do doctors, nurses, and patients have for hospital discharge? A mixed-methods study.
abstract: BACKGROUND
  The decision to discharge a patient from a hospital is a complex process governed by many medical and non-medical factors, while the actual reasons for discharge frequently remain ill-defined.
  
  
  OBJECTIVE
  To define relevant discharge criteria as perceived by doctors, nurses and patients for the development of a standard hospital discharge policy, we collected actual reasons and most pivotal medical and organisational criteria for discharge among all stakeholders.
  
  
  METHODS
  A tertiary referral university teaching hospital.
  
  
  METHODS
  We conducted a mixed methods analysis, using patient questionnaires, interviews and a focus group with caregivers, and observations during the daily rounds of doctors, nurses and patients during their hospital stay. Fourteen wards of the Surgery, Paediatrics and Neurology departments contributed.
  
  
  RESULTS
  We observed 426 patients during their hospital stay. Forty doctors and nurses were interviewed, and 7 senior nurses attended a focus group. The most commonly used discharge criteria were clinical factors, organisational discharge issues and patient-related factors. A total of 269 patients returned their questionnaires. About one third of the adult patients and nearly half of the children (or their parents) felt their personal situation and assistance needed at home was insufficiently taken into account before discharge. Patients were least satisfied with the information given about what they were allowed to do or should avoid after discharge and their involvement in the planning of their discharge. Thus, besides obvious medical reasons for discharge, several non-medical reasons were signalled by all stakeholders as important issues to be improved.
  
  
  CONCLUSIONS
  A set of discharge criteria could be defined that is useful for a more uniform hospital discharge policy that may help reduce unnecessary length of stay and improve patient satisfaction.
authors.affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, The Netherlands; Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
authors.affiliation: Department of Paediatrics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Tump
authors.affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Josje A
authors.initials: JA
authors.lastname: Koenders
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Sieta
authors.initials: S
authors.lastname: Kleiterp
authors.affiliation: Department of Trauma Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, St Lucas Andreas Hospital, Amsterdam, The Netherlands.
authors.forename: Fleur E
authors.initials: FE
authors.lastname: Brölmann
mesh_terms: D022126:Access to Information; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009726:Nurses; D010348:Patient Care Team; D010351:Patient Discharge; D017060:Patient Satisfaction; D010820:Physicians; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D055815:Young Adult