The Hospital Discharge

Abstract

The hospital discharge is a handoff, ripe embedded structural risks and hazards that can result in passive or active failures among "sharp end" providers. These failures can result in medical errors and an array of postdischarge adverse events. There are now emerging data to suggest that postdischarge-related adverse events and rehospitalizations can be reduced through interventions at the time of hospital discharge. This article reviews the modifiable components of the hospital discharge process related to adverse events and rehospitalizations, including those relating to the characteristics of the hospital, patient, and clinician. Using multimethod analysis, our group described the principles thought to be important to the discharge process and delineated what we now call the reengineered discharge, a set of 11 discrete and mutually reinforcing components that we believe should be consistently part of every hospital discharge. Finally, we discuss the work or the National Quality Forum Consensus Standards Maintenance committee who, in 2006, added the hospital discharge as one of its "safe practices for better healthcare."