Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers

Hesselink, Gijs; Flink, Maria; Olsson, Mariann; Barach, Paul; Dudzik-Urbaniak, Ewa; Orrego, Carola; Toccafondi, Giulio; Kalkman, Cor; Johnson, Julie K; Schoonhoven, Lisette; Vernooij-Dassen, Myrra; Wollersheim, Hub; on behalf of the European HANDOVER Research Collaborative

doi:10.1136/bmjqs-2012-001165

Cited by 203Patient-Provider Communication in HealthcarePatient Satisfaction in HealthcareHospital Admissions and Outcomes

Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers

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Hesselink, Gijs, Flink, Maria, Olsson, Mariann, Barach, Paul, Dudzik-Urbaniak, Ewa, Orrego, Carola, Toccafondi, Giulio, Kalkman, Cor +5 more·2012·BMJ Quality & Safety

DOI 10.1136/bmjqs-2012-001165

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Abstract

Background: Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients. Objective: The aim of the paper is to explore the barriers and facilitators to patient-centred care in the hospital discharge process. Methods: A qualitative study using purposive sampling of 192 individual interviews and 26 focus group interviews was conducted in five European Union countries with patients and/or family members, hospital physicians and nurses, and community general practitioners and nurses. A modified Grounded Theory approach was used to analyse the data. Results: The barriers and facilitators were classified into 15 categories from which four themes emerged: (1) healthcare providers do not sufficiently prioritise discharge consultations with patients and family members due to time restraints and competing care obligations; (2) discharge communication varied from instructing patients and family members to shared decision-making; (3) patients often feel unprepared for discharge, and postdischarge care is not tailored to individual patient needs and preferences; and (4) pressure on available hospital beds and community resources affect the discharge process. Conclusions: Our findings suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients’ and families’ capabilities, needs and preferences. Future interventions should be directed at healthcare providers’ attitudes and their organisation's leadership, with a focus on improving communication among care providers, patients and families, and between hospital and community care providers.

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Due to disease progression, patients' perceptions of their own capability and condition management differed to their carers'.
“Due to disease progression, patients’ perceptions of their own capability and condition management differed to their carers’ [45, 75].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [75]
In “Dealing with competing interests” (page not specified), a physician describes a patient wanting to go home while the family says he cannot care for himself, supporting a difference in views about the patient’s capabilities. The paper does not attribute that difference to disease progression or establish a broader difference in perceptions of condition management. (LLM, conf=0.76)
Experimental — accuracy not yet measured
This enabled information sharing between carers and HCPs, and improved understanding of patient needs, subsequently impacting their ability to tailor discharge planning (CMOC4).
“This enabled information sharing between carers and HCPs, and improved understanding of patient needs, subsequently impacting their ability to tailor discharge planning (CMOC4) [43, 46, 52, 54, 75, 76].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [75]
The ‘Exchange of patient-specific information between hospital and community care providers’ section says timely information helps providers anticipate patients’ needs at discharge. The Conclusions also call for interactions involving patients, families and providers, but describe the link to accommodating individual needs as a hypothesis. These passages do not establish that information sharing between carers and healthcare professionals improved understanding and thereby enabled tailored discharge planning. Page numbers were not supplied for these passages. (LLM, conf=0.81)
Experimental — accuracy not yet measured
Pressure to comply with the system-level focus on occupancy targets and minimising length of stay further fuelled healthcare professionals' beliefs about patients with MLTCiD.
“Analysis suggested that pressure to comply with the system-level focus on occupancy targets and minimising length of stay further fuelled these beliefs, as older adults with dementia typically stay longer in hospital [41, 43, 48, 50, 75, 78, 84, 89, 91–93].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [75]
The “Pressure on available hospital beds” section reports that financial drivers and bed shortages pushed providers toward early discharge, supporting the claim’s general point about system pressure. The paper does not establish occupancy targets or length-of-stay targets, nor does it link those pressures to professionals’ beliefs about patients with MLTCiD or to longer hospital stays among older adults with dementia. Page numbers were not available in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Older adults with dementia typically stay longer in hospital.
“Analysis suggested that pressure to comply with the system-level focus on occupancy targets and minimising length of stay further fuelled these beliefs, as older adults with dementia typically stay longer in hospital [41, 43, 48, 50, 75, 78, 84, 89, 91–93].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [75]
The ‘Dealing with competing interests’ section mentions patients with dementia in the context of discharge planning, and ‘Pressure on available hospital beds’ describes pressure to discharge patients. Neither reports that older adults with dementia typically stay longer in hospital. Searches for dementia and length of stay found no passage addressing that comparison; page numbers were not available in our copy. (LLM, conf=0.76)
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Quality of outpatient parenteral antimicrobial therapy (OPAT) care from the patient’s perspective: a qualitative study
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TRANSIÇÃO DO CUIDADO DO HOSPITAL PARA O DOMICÍLIO: REVISÃO INTEGRATIVA
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Complexities of medicines safety: communicating about managing medicines at transition points of care across emergency departments and medical wards
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Validation of the patient activation measure in patients at discharge from hospitals and at distance from hospital care in Sweden
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The Family Caregiver Activation in Transitions (FCAT) Tool: A New Measure of Family Caregiver Self-Efficacy
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The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals’ views
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Effect of post-discharge virtual wards on improving outcomes in heart failure and non-heart failure populations: A systematic review and meta-analysis
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Structure, content, unsafe abbreviations, and completeness of discharge summaries: A retrospective analysis in a University Hospital in Austria
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Patient experiences of, and preferences for, surgical wound care education
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Eventos adversos decorrentes de falhas de comunicação: reflexões sobre um modelo para transição do cuidado
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Problems in continuity of medication management upon transition between primary and secondary care: patients’ and professionals’ experiences
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Active Life: a project for a safe hospital-community transition after arthroplasty
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Longitudinal medication reconciliation at hospital admission, discharge and post-discharge
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Chances for learning intraprofessional collaboration between residents in hospitals
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Cross-Sectional Study of Clients’ Satisfaction With Outpatient and Inpatient Services of Public Health Facilities of a North Indian State
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A trustful relationship—the importance for relatives to actively participate in the meeting with the physician
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The Impact of Peer Support Group Programs on Psychosocial Outcomes for Burn Survivors and Caregivers: A Review of the Literature
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Exploring Differences in Patient-Centered Practices among Healthcare Professionals in Acute Care Settings
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Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: a before and after study
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An ethnographic study comparing approaches to inter-professional knowledge sharing and learning in discharge planning and care transitions
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Fragmented care in the era of limited work hours: a plea for an explicit handover curriculum
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Time of admission and mortality after hip fracture: a detailed look at the weekend effect in a nationwide study of 55,211 hip fracture patients in Norway
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Teach-back of discharge instructions in the emergency department: a pre–post pilot evaluation
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Patient Preparation for Transitions of Surgical Care: Is Failing to Prepare Surgical Patients Preparing Them to Fail?
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The Experience of Transitional Care for Non-Medically Complex Older Adults and Their Family Caregivers
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Surgical patients’ perspectives on nurses’ education on post-operative care and follow up in Northern Ghana
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UK hospital patient discharge: the patient perspective
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Caregiver Experiences of Care Coordination for Recently Discharged Patients: A Qualitative Metasynthesis
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Decision-making about changing medications across transitions of care: Opportunities for enhanced patient and family engagement
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Improvement of transitional care from hospital to home for older patients, the TIGER study: protocol of a randomised controlled trial
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Shared Decision Making: A Fundamental Tenet in a Conceptual Framework of Integrative Healthcare Delivery
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Preparing for Home: a before-and-after study to investigate the effects of a neonatal discharge package aimed at increasing parental knowledge, understanding and confidence in caring for their preterm infant before and after discharge from hospital
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Patients' participation during treatment and care of breast cancer – a possibility and an imperative
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Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review
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Navigating outpatient care of patients with type 2 diabetes after hospital discharge - a qualitative longitudinal study
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Measuring and improving comprehensive pediatric cardiac care: Learning from continuous quality improvement methods and tools
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Health Care Worker Perceptions of Gaps and Opportunities to Improve Hospital-to-Hospice Transitions
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Investigating discharge communication for chronic disease patients in three hospitals in India
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Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes
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Health professionals' and patients' perceptions of patient-centered care : a comparison
Sidani, S., van Soeren, M., Hurlock‐Chorostecki, C., Reeves, S., Fox, M. T., & Collins, L. (2016) · Research Repository (Kingston University London) · Cited by 15 · see citing works
Evaluating the feasibility of a web-based discharge education programme to improve general surgical patients’ postdischarge recovery: a pilot randomised controlled trial
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Experiences and Perceptions of Medication Management Communication During Transitions of Care for Residents in Aged Care Homes and Their Caregivers: A Qualitative Meta‐Synthesis
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Understanding barriers and facilitators to therapeutic relationships in state psychiatric hospitals
Keefe, K., Cardemil, E. V., & Thompson, M. F. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22866 · Cited by 13 · see citing works
Hospitals´ Discharge Tendency and Risk of Death - An Analysis of 60,000 Norwegian Hip Fracture Patients
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“The light at the end of the tunnel”. Discharge experience of older patients with chronic diseases: A multi‐centre qualitative study
Facchinetti, G., Albanesi, B., Piredda, M., Marchetti, A., Ausili, D., Ianni, A., Mauro, S. D., & Marinis, M. G. D. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.14790 · Cited by 13 · see citing works
An intervention to improve transitions from NICU to ambulatory care: quasi-experimental study
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Improving mental health care transitions through information capture during admission to inpatient mental health services: a quality improvement study
Tyler, N., Wright, N., Gregoriou, K., & Waring, J. J. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-07136-2 · Cited by 12 · see citing works
Risk of suicide after hospitalizations due to acute physical health conditions—a cohort study of the Norwegian population
Asheim, A., Nilsen, S. M., Svedahl, E. R., Kaspersen, S. L., Bjerkeset, O. A., Janszky, I., & Bjø‌rngaard, J. H. (2024) · BMC Medicine · doi:10.1186/s12916-024-03623-5 · Cited by 12 · see citing works
Medication management during transitions from hospital to home: a focus group study with hospital and primary healthcare providers in the Netherlands
Daliri, S., Bekker, C. L., Buurman, B. M., Reimer, W. J. M. S. O., van den Bemt, B. J. F., & Karapinar‐Çarkit, F. (2020) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-020-01189-9 · Cited by 12 · see citing works
A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent
Gadsby, E. W., Wistow, G., & Billings, J. R. (2022) · Critical Social Policy · doi:10.1177/02610183211065028 · Cited by 12 · see citing works
Potential drug-to-drug interactions: a cross-sectional study among older patients discharged from hospital to home care
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The value of caregiver inclusive practices in geriatric transitions of care: A systematic review
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Development of a web‐based discharge education intervention to improve the postdischarge recovery of general surgical patients
Kang, E., Gillespie, B. M., Tobiano, G., & Chaboyer, W. P. (2021) · Journal of Nursing Scholarship · doi:10.1111/jnu.12717 · Cited by 13 · see citing works
How can communication to GPs at hospital discharge be improved? A systems approach
Boddy, N., Barclay, S., Bashford, T., & Clarkson, P. J. (2021) · BJGP Open · doi:10.3399/bjgpo.2021.0148 · Cited by 19 · see citing works
Race and Ethnicity Influences Outcomes of Adult Burn Patients
DiPaolo, N., Hulsebos, I. F., Yu, J., Gillenwater, J. T., & Yenikomshian, H. A. (2023) · Journal of Burn Care & Research · doi:10.1093/jbcr/irad033 · Cited by 11 · see citing works
What can artefact analysis tell us about patient transitions between the hospital and primary care? Lessons from the HANDOVER project
Johnson, J. K., Arora, V. M., Barach, P. R., & Collaborative, O. B. O. T. E. H. R. (2013) · European Journal of General Practice · doi:10.3109/13814788.2013.819850 · Cited by 11 · see citing works
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Discharge Communication: A Multi-Institutional Survey of Internal Medicine Residents’ Education and Practices
Trivedi, S. P., Kopp, Z. S., Tang, A. J., Mammen, A., Pandya, D. S., Horwitz, L. I., & Schwartz, M. D. (2020) · Academic Medicine · doi:10.1097/acm.0000000000003896 · Cited by 11 · see citing works
Measuring health literate discharge practices
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Understanding clinician influences and patient perspectives on outpatient discharge decisions: a qualitative study
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Views and experiences with regard to antibiotic use of hospitalized patients in five European countries: a qualitative descriptive study
Zanichelli, V., Monnier, A. A., Tebano, G., Stanić, B. M., Gyssens, I. C., Pulcini, C., Vlahović–Palčevski, V., Schindler, M., Harbarth, S., Hulscher, M., et al. (2018) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2018.04.030 · Cited by 11 · see citing works
Perceptions of emergency care using a seizure care pathway for patients presenting to emergency departments in the North West of England following a seizure: a qualitative study
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Diversity in Medical Education
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Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review
Lawson, L., Cooper, M., Tolley, C., Hand, A., & Nazar, H. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06123-0 · Cited by 10 · see citing works
“Analysis suggested that pressure to comply with the system-level focus on occupancy targets and minimising length of stay further fuelled these beliefs, as older adults with dementia typically stay longer in hospital [41, 43, 48, 50, 75, 78, 84, 89, 91–93].”
How can communication to GPs at hospital discharge be improved? A Systems Approach
Boddy, N., Barclay, S. I. G., Bashford, T., & Clarkson, P. (2021) · Apollo (University of Cambridge) · doi:10.17863/cam.74324 · Cited by 10 · see citing works

Quality and safety of hospital discharge: a study on experiences and perceptions of patients, relatives and care providers
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Patient Perspectives of the Hospital Discharge Process: A Qualitative Study
Jones, K. C., Austad, K., Silver, S. R., Cordova-Ramos, E. G., Fantasia, K. L., Perez, D. C., Kremer, K., Wilson, S., Walkey, A. J., & Drainoni, M. (2023) · Journal of Patient Experience · doi:10.1177/23743735231171564 · Cited by 24 · see citing works
Reducing delayed transfer of care in older people: A qualitative study of barriers and facilitators to shorter hospital stays
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Exploring Issues and Challenges Faced by Patients and Family Care Givers Regarding Readiness for Hospital Discharge. A qualitative Study.
Ali, N., Shah, B. A., Anwar, M., Ishfaq, S., Hussain, S., Bushra, M., & Asim (2024) · History of Medicine/ru · doi:10.48047/hm.10.1.2024.235-246
Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals
Wong, E. L., Yam, C. H., Cheung, A. W., Leung, M. C. M., Chan, F. W., Wong, F. Y., & Yeoh, E. (2011) · BMC Health Services Research · doi:10.1186/1472-6963-11-242 · Cited by 149 · see citing works

Authors: Hesselink, G., Flink, M., Olsson, M., Barach, P., Dudzik-Urbaniak, E., Orrego, C., Toccafondi, G., Kalkman, C., Johnson, J. K., Schoonhoven, L., Vernooij-Dassen, M., Wollersheim, H., & Collaborative, O. B. O. T. E. H. R.
Affiliations: Radboud University Medical Center (NL)
Karolinska University Hospital (SE)
University College Cork (IE)
National Center for Quality Assessment in Health Care, Krakow, Poland
Universitat Autònoma de Barcelona (ES)
Regione Toscana (IT)
University Medical Center Utrecht (NL)
UNSW Sydney (AU)
Corresponding author: Hesselink, Gijs
ORCID: Hesselink, Gijs
Flink, Maria
Olsson, Mariann
Barach, Paul
Orrego, Carola
Toccafondi, Giulio
Kalkman, Cor
Johnson, Julie K
Schoonhoven, Lisette
Vernooij-Dassen, Myrra
Venue: BMJ Quality & Safety
Publisher: BMJ
Published: 2012-11-01
Volume: 21
Issue: Suppl 1
Pages: i39-i49
ISSN: 1475-3898 (ISSN-L)
2044-5415
2044-5423
DOI: 10.1136/bmjqs-2012-001165
OpenAlex: W2099043395
Cited by: 203
References: 56
Citations by year: 2026: 5 · 2025: 16 · 2024: 25 · 2023: 13 · 2022: 15 · 2021: 15 · 2020: 18 · 2019: 17 · 2018: 20 · 2017: 20 · 2016: 9 · 2015: 9 · 2014: 9 · 2013: 9 · 2012: 2
FWCI: 16.45
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
Locations: BMJ Quality & Safety (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
ePrints Soton (University of Southampton) (acceptedVersion)
Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc)
HighWire Press Open Archive (submittedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Funders: European Commission (223409)
FP7 Health
Topics: Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
Keywords: hospital discharge, patient-centered care, shared decision-making, discharge communication, barriers and facilitators, patient and family involvement, post-discharge care, hospital bed pressure, hospital-community care transition, patient readiness, clinician attitudes
MeSH terms: Adult, Chronic Disease, Cross-Cultural Comparison, Decision Making, European Union, Family, Health Personnel, Health Services Needs and Demand, Humans, Interviews as Topic, Health Knowledge, Attitudes, Practice, Patient Discharge, Patients, Focus Groups, Efficiency, Organizational, Patient-Centered Care, Qualitative Research, Patient Handoff

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Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers

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