LR9 / Clinical risk management (CRM) practice on patient discharge

Type of Patient Safety Practice
Clinical Practice (CP)
Related practices from PaSQ database
“Best fit” category of the reported practice


Patient safety theme the SCP/clinical risk management practice is aimed at
Patient discharge
Objective of the CRM practice
Patient safety could be jeopardised resulting in substandard medical care if poor care co-ordination occurs at the time of hospital discharge. A low- cost intervention is designed to reconnect patients to the primary care provider after hospital discharge promptly. The intervention requires no new personnel other than the ones already involved in the care of the patients.
Short description of the CRM practice, including any references for further information
A four- step discharge-transfer intervention consisting of :
1. Comprehensive, user-frendly patient discharge form provided to patients in one of 3 languages
2. Electronic transfer of Patient Discharge Form to the registered nurse (RN) at the patient’s primary care site.
3. Telephone contact by a primary care RN to the patient after discharge.
4. Primary care provider’s (PCP) review and modification of the discharge-transfer plan.
See Balaban et al 2007[1] for additional information on the Patient Discharge Form.
Innovator of the SCP, country of origin
Havard Medical School, Boston. United States
Involved health care staff
Nurses, physicians
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
Community hospitals / Medical, Surgical [1]
Summary of evidence for effectiveness, including references
The discharge-transfer intervention significantly increased the rate of timely outpatient follow-up and the completion rates of recommended outpatient workups[1]. Improved outcomes after hospital discharge were reported from studies that explored the use of transition coaches, advanced practice nurses and pahrmacists[2-5].
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
Post discharge follow- up by telephone to supplement standard care reduced hospital readmissions in patients with chronic diseases [6]. Follow-up call by a pharmacist 2-4 days after discharge to reinforce discharge plan and review medication reduced hospital readmission 30 days after discharge[7].
Summary of available information on feasibility, including references
Study result may not be generalizable becasue the study sample was small and other outcomes such as cost savings, health improvments or decreased resource utilisation was not evaluated. In addition, the study was conducted within a single hospital and all patients had their PCP and majority of their care within thesame system. Therefore, it was not possible to assess how the discharge-transfer intervention would cope if the patient had a readmission or speacialty care at an outside institution[1].
Existing implementation tools, including references
Potential for/description of patient involvement in the CRM practice, including references
The Patient Discharge form provided written discharge information for the patient, empowering them to participate more actively in their outpatient care[1].
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
[1] Balaban RB, Weissman JS, Samuel PA, Woolhandler S (2008) Redefining and redesigning hospital discharge to enhance patient care: a randomized controlled study. J Gen Intern Med 23:1228-1233
[2] Coleman EA, Parry C, Chalmers S, Min SJ (2006) The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 166:1822-1828
[3] Dudas V, Bookwalter T, Kerr KM, Pantilat SZ (2001) The impact of follow-up telephone calls to patients after hospitalization. Am J Med 111:26S-30S
[4] Naylor MD, McCauley KM (1999) The effects of a discharge planning and home follow-up intervention on elders hospitalized with common medical and surgical cardiac conditions. J Cardiovasc Nurs 14:44-54
[5] Phillips CO, Wright SM, Kern DE, Singa RM, Shepperd S, Rubin HR (2004) Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis. JAMA 291:1358-1367
[6] Harrison PL, Hara PA, Pope JE, Young MC, Rula EY (2011) The impact of postdischarge telephonic follow-up on hospital readmissions. Popul Health Manag 14:27-32
[7] Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O’Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L (2009) A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med 150:178-187
Any additional information on the CRM (e.g. implementation barriers and drivers)