Hospital-to-Home: Easing the Transition

When it comes to discharging patients from the hospital, those in the healthcare field are all too familiar with the "quicker, sicker" phenomenon -- patients who leave the hospital too quickly are more likely to suffer a relapse of some kind. Nonetheless, overcrowding encourages shorter average stays at many facilities. One outcome of this trend is increased dependence upon other organizations to provide care and assistance once the patient returns home. Achieving success in this situation demands not only the provision of quality care within both inpatient and home health environments, but also the successful coordination of care between the two environments.

Satisfaction With Inpatient and Home Healthcare

According to Gallup's 2002 patient satisfaction and loyalty database, overall satisfaction levels are relatively high among both inpatients and home healthcare patients, and there was no significant change in these scores between 2001 and 2002. Home healthcare, which generally takes the form of an ongoing personal relationship between the patient and caregiver, exhibits higher levels of satisfaction than inpatient care.

Also, nearly two-thirds of home healthcare patients (65%) report being very satisfied with the care they received. Among inpatients, nearly three in five are very satisfied. Although these scores are high, there is potential for improvement in both service areas.

Continuity of Care

While patients continue to exhibit high levels of satisfaction with the care that hospitals and home health agencies deliver, they seem to be somewhat less satisfied with the coordination process between these two services. One of the core items on Gallup's inpatient satisfaction questionnaire is the level of satisfaction with "assistance in planning for care after discharge, such as arranging for home care, nursing home care, or use of medical equipment."

The mean level of satisfaction with assistance in planning for care after discharge is 3.39 -- significantly lower than overall satisfaction with both inpatient and home healthcare. Also, less than half of respondents reported being very satisfied with this aspect of their inpatient experiences.

Implications

Patient satisfaction with assistance in planning for aftercare can be related to myriad institutions and people. But there is clearly significant room for improvement in this area, especially when it is compared to overall satisfaction with inpatient and home health services. The following are some keys to success in improving satisfaction with the continuum of care:

• Identify aftercare needs and begin planning for them as early as possible during the inpatient experience. Using hospital information systems to flag patients with high potential for aftercare needs upon admission would support this process.

• Following the early identification of potential need, a team including the primary physician, nursing staff, and discharge planning staff should begin assembling a discharge plan and discussing it with both the patient and family members. Early discussion with the patient and family members helps to flag potential issues with the home support structure, and also educates the patient and family about potential home care needs.

• The hospital and family should also make home healthcare and medical equipment decisions as far in advance of patient discharge as possible. This allows for the aftercare provider(s) to have input into the discharge plan, eases scheduling for the initiation of services, and supports further involvement and education of the patient and family.