Improving handoff communication from hospital to home: the development, implementation and evaluation of a personalized patient discharge letter

Int J Qual Health Care. 2016 Jun;28(3):384-90. doi: 10.1093/intqhc/mzw046. Epub 2016 May 25.


Objective: To develop, implement and evaluate a personalized patient discharge letter (PPDL) to improve the quality of handoff communication from hospital to home.

Design: From the end of 2006-09 we conducted a quality improvement project; consisting of a before-after evaluation design, and a process evaluation.

Setting: Four general internal medicine wards, in a 1024-bed teaching hospital in Amsterdam, the Netherlands.

Participants: All consecutive patients of 18 years and older, admitted for at least 48 h.

Interventions: A PPDL, a plain language handoff communication tool provided to the patient at hospital discharge.

Main outcome measures: Verbal and written information provision at discharge, feasibility of integrating the PPDL into daily practice, pass rates of PPDLs provided at discharge.

Results: A total of 141 patients participated in the before-after evaluation study. The results from the first phase of quality improvement showed that providing patient with a PPDL increased the number of patients receiving verbal and written information at discharge. Patient satisfaction with the PPDL was 7.3. The level of implementation was low (30%). In the second phase, the level of implementation improved because of incorporating the PPDL into the electronic patient record (EPR) and professional education. An average of 57% of the discharged patients received the PPDL upon discharge. The number of discharge conversations also increased.

Conclusion: Patients and professionals rated the PPDL positively. Key success factors for implementation were: education of interns, residents and staff, standardization of the content of the PPDL, integrating the PPDL into the electronic medical record and hospital-wide policy.

Keywords: handover; patient discharge; patient satisfaction; patient-centered care; patient-centered communication.

MeSH terms

  • Adult
  • Aged
  • Communication*
  • Electronic Health Records / standards
  • Female
  • Hospitals, Teaching / organization & administration*
  • Hospitals, Teaching / standards
  • Humans
  • Inservice Training
  • Male
  • Middle Aged
  • Netherlands
  • Patient Discharge / standards*
  • Patient Satisfaction
  • Policy
  • Quality Improvement / organization & administration*
  • Quality Improvement / standards