MedStar Authors catalog › Details for: We Want to Know: Eliciting Hospitalized Patients' Perspectives on Breakdowns in Care.
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We Want to Know: Eliciting Hospitalized Patients' Perspectives on Breakdowns in Care.

by Smith, Kelly; Morales, Crystal.
Citation: Journal of Hospital Medicine (Online). 12(8):603-609, 2017 Aug.Journal: Journal of hospital medicine.Published: 2017ISSN: 1553-5592.Full author list: Fisher K; Smith K; Gallagher T; Burns L; Morales C; Mazor K.UI/PMID: 28786425.Subject(s): Aged | *Communication | *Continuity of Patient Care/sn [Statistics & Numerical Data] | Female | Humans | Interviews as Topic | *Length of Stay/sn [Statistics & Numerical Data] | Male | Medical Errors/sn [Statistics & Numerical Data] | Middle Aged | Patient Discharge/sn [Statistics & Numerical Data] | Patients/px [Psychology] | *Patients/sn [Statistics & Numerical Data]Institution(s): MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment(s): MedStar Health, System Quality and Patient SafetyActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.12788/jhm.2783 (Click here) Abbreviated citation: J Hosp Med. 12(8):603-609, 2017 Aug.Local Holdings: Available in print through MWHC library: 2007 only.Abstract: BACKGROUND: There is increasing recognition that patients have critical insights into care experiences, including breakdowns in care. Harnessing patient perspectives for hospital improvement requires an in-depth understanding of the types of breakdowns patients identify and the impact of these events.Abstract: METHODS: We interviewed a broad sample of patients during hospitalization and postdischarge to elicit patient perspectives on breakdowns in care. Through an iterative process, we developed a categorization of patient-perceived breakdowns called the Patient Experience Coding Tool.Abstract: RESULTS: Of 979 interviewees, 386 (39.4%) believed they had experienced at least one breakdown in care. The most common reported breakdowns involved information exchange (n = 158, 16.1%), medications (n = 120, 12.3%), delays in admission (n = 90, 9.2%), team communication (n = 65, 6.6%), providers' manner (n = 62, 6.3%), and discharge (n = 56, 5.7%). Of the 386 interviewees who reported a breakdown, 140 (36.3%) perceived associated harm. Patient- perceived harms included physical (eg, pain), emotional (eg, distress, worry), damage to relationship with providers, need for additional care or prolonged hospital stay, and life disruption. We found higher rates of reporting breakdowns among younger ( <60 years old) patients (45.4% vs 34.5%, ? < 0.001), those with at least some college education (46.8% vs 32.7%, ? < 0.001), and those with another person (family or friend) present during the interview or interviewed in lieu of the patient (53.4% vs 37.8%, ? = 0.002).Abstract: CONCLUSIONS: When asked directly, almost 4 out of 10 hospitalized patients reported a breakdown in their care. Patient- perceived breakdowns in care are frequently associated with perceived harm, illustrating the importance of detecting and addressing these events.

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