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Background: The number of quality indicators for which clinicians need to record data is increasing. For many indicators, there are concerns about their efficacy. This study aimed to determine whether working with only a consensus-based core set of quality indicators in the intensive care unit (ICU) reduces the time spent on documenting performance data and administrative burden of ICU professionals, and if this is associated with more joy in work without impacting the quality of ICU care., Methods: Between May 2021 and June 2023, ICU clinicians of seven hospitals in the Netherlands were instructed to only document data for a core set of quality indicators. Time spent on documentation, administrative burden and joy in work were collected at three time points with validated questionnaires. Longitudinal data on standardised mortality rates (SMR) and ICU readmission rates were gathered from the Dutch National Intensive Care registry. Longitudinal effects and differences in outcomes between ICUs and between nurses and physicians were statistically tested., Results: A total of 390 (60%), 291 (47%) and 236 (40%) questionnaires returned at T0, T1 and T2. At T2, the overall median time spent on documentation per day was halved by 30 min (p<0.01) and respondents reported fewer unnecessary and unreasonable administrative tasks (p<0.01). Almost one-third still experienced unnecessary administrative tasks. No significant changes over time were found in joy in work, SMR and ICU readmission., Conclusions: Implementing a core set of quality indicators reduces the time ICU clinicians spend on documentation and administrative burden without negatively affecting SMR or ICU readmission rates. Time savings can be invested in patient care and improving joy in work in the ICU., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: With the 'teach-back' method, patients or carers repeat back what they understand, so that professionals can confirm comprehension and correct misunderstandings. The effectiveness of teach-back has been underexamined, particularly for older patients discharged from the emergency department (ED). We aimed to determine whether teach-back would reduce ED revisits and whether it would increase patients' retention of discharge instructions, improve self-management at home and increase satisfaction with the provision of instructions., Methods: A nonrandomised pre-post pilot evaluation in the ED of one Dutch academic hospital including patients discharged from the ED receiving standard discharge care (pre) and teach-back (post). Primary outcomes were ED-revisits within 7 days and within 8-30 days postdischarge. Secondary outcomes for a subsample of older adults were retention of instructions, self-management 72 hours after discharge and satisfaction with the provision of discharge instructions., Results: A total of 648 patients were included, 154 were older adults. ED revisits within 7 days and within 8-30 days were lower in the teach-back group compared with those receiving standard discharge care: adjusted odds ratios (AORs) of 0.23 (95% CI 0.05 to 1.07) and 0.42 (95% CI 0.14 to 1.33), respectively. Participants in the teach-back group had an increased likelihood of full knowledge retention on information related to their ED diagnosis and treatment (AOR 2.19; 95% CI 1.01 to 4.75; p=0.048), medication (AOR 14.89; 95% CI 4.12 to 53.85; p>0.001) and follow-up appointments (AOR 3.86; 95% CI 1.33 to 10.19; p=0.012). Use of teach-back was not significantly associated with improved self-management and higher satisfaction with discharge instructions. Discharge conversations were generally shorter for participants receiving teach-back., Conclusions: Discharging patients from the ED with a relatively simple and feasible teach-back method can contribute to safer and better transitional care from the ED to home., Competing Interests: Competing interests: None., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Safe patient transitions depend on effective communication and a functioning care coordination process. Evidence suggests that primary care physicians are not satisfied with communication at transition points between inpatient and ambulatory care, and that communication often is not provided in a timely manner, omits essential information, or contains ambiguities that put patients at risk., Objective: Our aim was to demonstrate how process mapping can illustrate current handover practices between ambulatory and inpatient care settings, identify existing barriers and facilitators to effective transitions of care, and highlight potential areas for quality improvement., Methods: We conducted focus group interviews to facilitate a process mapping exercise with clinical teams in six academic health centres in the USA, Poland, Sweden, Italy, Spain and the Netherlands., Findings: At a high level, the process of patient admission to the hospital through the emergency department, inpatient care, and discharge back in the community were comparable across sites. In addition, the process maps highlighted similar barriers to providing information to primary care physicians, inaccurate or incomplete information on referral and discharge, a lack of time and priority to collaborate with counterpart colleagues, and a lack of feedback to clinicians involved in the handovers., Conclusions: Process mapping is effective in bringing together key stakeholders and makes explicit the mental models that frame their understanding of the clinical process. Exploring the barriers and facilitators to safe and reliable patient transitions highlights opportunities for further improvement work and illustrates ideas for best practices that might be transferrable to other settings.

Background: Much of the research on improving patient handovers has focused on enhancing communication within the hospital system, but there have been relatively few efforts aimed at addressing the challenges at the interface between the hospital and the primary care setting., Methods: A qualitative thematic analysis using a clinical microsystems lens applied to 28 semi-structured key stakeholder interviews in the Netherlands. Data were organised into seven 'virtual' clinical microsystem datasets composed of patients, hospital-based physicians, hospital-based nurses and community-based general practitioners., Results: Five themes that contributed to effective or ineffective handovers emerged from our analysis: (1) lack of adequate information; (2) healthcare professionals' availability and opportunity for personal contact; (3) feedback, teaching and protocols related to handovers; (4) information technology facilitated communication solutions; and (5) the role and responsibility of patients. Our analysis suggests that each healthcare professional attempted to provide the best care possible, but did this largely in isolation, and without the benefit of the knowledge and expertise of the other members of the microsystem., Conclusions: The microsystem approach offers an innovative organisational construct and approach to assess the gaps in 'hospital to community' patient handovers, by viewing the hospital to the community interface as a clinical microsystem continuum. Our application of the microsystem approach confirms and extends earlier findings about the impact of barriers on the continuity and safety of patient transitions and their impact on the quality of patient care.

Background: Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients., Objective: The aim of the paper is to explore the barriers and facilitators to patient-centred care in the hospital discharge process., Methods: A qualitative study using purposive sampling of 192 individual interviews and 26 focus group interviews was conducted in five European Union countries with patients and/or family members, hospital physicians and nurses, and community general practitioners and nurses. A modified Grounded Theory approach was used to analyse the data., Results: The barriers and facilitators were classified into 15 categories from which four themes emerged: (1) healthcare providers do not sufficiently prioritise discharge consultations with patients and family members due to time restraints and competing care obligations; (2) discharge communication varied from instructing patients and family members to shared decision-making; (3) patients often feel unprepared for discharge, and postdischarge care is not tailored to individual patient needs and preferences; and (4) pressure on available hospital beds and community resources affect the discharge process., Conclusions: Our findings suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients' and families' capabilities, needs and preferences. Future interventions should be directed at healthcare providers' attitudes and their organisation's leadership, with a focus on improving communication among care providers, patients and families, and between hospital and community care providers.

Background: Patient safety experts have postulated that increasing patient participation in communications during patient handovers will improve the quality of patient transitions, and that this may reduce hospital readmissions. Choosing strategies that enhance patient safety through improved handovers requires better understanding of patient experiences and preferences for participation., Objective: The aim of this paper is to explore the patients' experiences and perspectives related to the handovers between their primary care providers and the inpatient hospital., Methods: A qualitative secondary analysis was performed, based on individual and focus group patient interviews with 90 patients in five European countries., Results: The analysis revealed three themes: patient positioning in the handover process; prerequisites for patient participation and patient preferences for the handover process. Patients' participation ranged from being the key actor, to sharing the responsibility with healthcare professional(s), to being passive participants. For active participation patients required both personal and social resources as well as prerequisites such as information and respect. Some patients preferred to be the key actor in charge; others preferred their healthcare professionals to be the key actors in the handover., Conclusions: Patients' participation is related to the healthcare system, the activity of healthcare professionals' and patients' capacity for participation. Patients prefer a handover process where the responsibility is clear and unambiguous. Healthcare organisations need a clear and well-considered system of responsibility for handover processes, that takes into account the individual patient's need of clarity, and support in relation to his/hers own recourses.