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Objective: To give an overview of instruments for early detection of quality and safety risks for integrated risk management in hospitals., Design: Systematic literature review and qualitative research., Method: A review of literature in three databases (PubMed, CINAHL and Embase) was conducted to establish which instruments are known from academic literature. Articles were selected if the effectiveness and feasibility of the instrument for risk management had been evaluated. We also examined the references of the articles found, and searched for grey literature. Moreover, 19 experts from healthcare and other sectors were interviewed in order to verify which instruments are used in practice and to study the factors influencing implementation in hospitals., Results: We found more than 60 instruments which we divided into 12 categories. Interviewees reported that a combination of instruments is required in order to assess all of the quality and safety risks, the main elements being: (a) the patient as source; (b) brainstorming sessions and consultation in networks, i.e. verbal exchange of risks between departments and organisations; (c) insight into the performance of individual healthcare professionals and teams; and (d) site visits. For instruments to work as effectively as possible, a culture is essential in which care providers recognise and discuss risks. There is also a need for a management system including all hospital risks, allowing an integrated, efficient approach to risk., Conclusion: There are several instruments for early detection of quality and safety risks for integrated risk management in hospitals. The predictive value of the instruments requires further investigation.

Background: There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge., Methods: The Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance., Results: Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change., Conclusions: This study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.

Background: Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown., Objectives: To explore aspects of organizational culture to develop a deeper understanding of the discharge process., Research Design: A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data., Subjects: In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses., Results: Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a "here and now" situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices., Conclusions: On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.