title: Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers' perceptions.
abstract: BACKGROUND
  The complex process of discharging patients from acute care to community care requires a multifaceted interaction between all health care providers and patients. Poor communication in a patient's discharge can result in post hospital adverse events, readmission, and mortality. Because of the gravity of these problems, discharge planning has been emphasized as a potential solution. The purpose of this paper is to identify communication barriers to effective discharge planning in an acute care unit of a tertiary care center and to suggest solutions to these barriers.
  
  
  METHODS
  Health care providers provided comments to a single open-ended question: "What are the communication barriers between the different health care providers that limit an effective discharge of patients from Unit 36?" We conducted qualitative thematic analysis by identifying themes related to communication barriers affecting a successful discharge process.
  
  
  RESULTS
  Three broad themes related to barriers to the discharge process were identified: communication, lack of role clarity and lack of resources. We also identified two themes for opportunities for improvement, ie, structure and function of the medical team and need for leadership.
  
  
  CONCLUSIONS
  While it was evident that poor communication was an overarching barrier identified by health care providers, other themes emerged. In an effort to increase inter-team communication, "bullet rounds", a condensed form of discharge rounds, were introduced to the medical teaching unit and occurred on a daily basis between the multidisciplinary team. To help facilitate provider-patient communication, electronic transfer of care summaries were suggested as a potential solution. To help role clarity, a discharge coordinator and/or liaison was suggested. Communication can be enhanced through use of electronic discharge summaries, bullet rounds, and implementation of a discharge coordinator(s). The findings from this study can be used to aid future researchers in devising appropriate discharging strategies that are focused around the patient and inter-health care provider communication.
authors.affiliation: Department of Community Health Sciences, W21C Research and Innovation Centre, Institute of Public Health, University of Calgary, Calgary, AB, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Okoniewska
authors.affiliation: Department of Community Health Sciences, W21C Research and Innovation Centre, Institute of Public Health, University of Calgary, Calgary, AB, Canada.
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Santana
authors.affiliation: Department of Internal Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Horacio
authors.initials: H
authors.lastname: Groshaus
authors.affiliation: Community Based Practice, Alberta Health Services, Calgary, AB, Canada.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Stajkovic
authors.affiliation: Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cowles
authors.affiliation: Department of Quality and Healthcare Improvement, Alberta Health Services, Calgary, AB, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Chakrovorty
authors.affiliation: Department of Community Health Sciences, W21C Research and Innovation Centre, Institute of Public Health, University of Calgary, Calgary, AB, Canada.
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
keywords: acute care setting; barriers; communication; continuum of care; discharge planning