Forty Percent of Patients Report a Disconnect in Medical Care
Researchers recommend developing sustainable methods to overcome patients' reluctance to report breakdowns in care.
About 4 in 10 hospitalized patients reported a breakdown in their care, including information exchange, delays in admission, team communication, and discharge, according to a study published in the Journal of Hospital Medicine.
Kimberly A. Fisher, MD, MSc, from the Meyers Primary Care Institute in Worcester, Mass., and colleagues interviewed a broad sample of patients during hospitalization and post-discharge to elicit patient perspectives on breakdowns in care. Interviews were conducted in 2 hospitals between June 2014 and February 2015. Three medical-surgical units (MSUs) at each hospital participated. Patients were eligible if they were at least 18 years old, able to speak English or Spanish, and admitted to the hospital for more than 24 hours. Interviews were conducted in person while the patients were hospitalized or via telephone 7 to 30 days post-discharge.
A total of 979 outreach interviews were conducted. Of these, 349 were conducted via telephone post-discharge, and 630 were conducted in person during hospitalization. Of the patients approached to participate, 67% completed an interview (61% in person, 83% via telephone).
The most common reported breakdowns involved information exchange (n = 158, 16.1%), medications (120, 12.3%), delays in admission (90, 9.2%), team communication (65, 6.6%), providers' manner (62, 6.3%), and discharge (56, 5.7%). Of the 386 interviewees who reported a breakdown, 140 (36.3%) perceived associated harm. This included physical harm, emotional harm, damage to their relationship with providers, need for additional care or prolonged hospital stay, and life disruption.
The authors found higher rates of reporting breakdowns among patients younger than age 60 (45.4% vs 34.5% in those older than age 60), those with at least some college education (46.8% vs 32.7% in those with a high school education or less), and those with another person (family or friend) present during the interview or interviewed in place of the patient (53.4% vs 37.8%).
“When directly asked about their experiences, almost 4 out of 10 hospitalized patients reported a breakdown in their care, many of which were perceived to be harmful,” the authors stated. “Not all hospitals will have the resources to implement the intensive approach used in this study to elicit patient-perceived breakdowns. Therefore, further work is needed to develop sustainable methods to overcome patients' reluctance to report breakdowns in care.”
Fisher K, Smith K, Gallagher T, Burns L, Morales C, Mazor K. We want to know: eliciting hospitalized patients' perspectives on breakdowns in care. J Hosp Med. 2017; 12(8): 603-609.