• Gijs Hesselink, Lisette Schoonhoven, Marieke Plas, Hub Wollersheim, and Myrra Vernooij-Dassen.
• Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQ Healthcare, 6500 HB Nijmegen, The Netherlands. g.hesselink@iq.umcn.nl
• Int J Qual Health Care. 2013 Feb 1;25(1):66-74.

ObjectiveTo identify barriers experienced and perceived at discharge by physicians, nurses, patients and relatives.DesignWe developed questionnaires based on focus group interviews with hospital and community care providers, and individual interviews with patients and relatives. A survey was conducted among patients, relatives and related nurses and physicians from hospital and community care.SettingOne university hospital and the related community care area in the Netherlands.ParticipantsThirty health-care providers and eight patients and/or relatives participated in focus group and individual interviews. Questionnaires were returned by 344 health-care providers and 206 patients and relatives.ResultsInformation from the hospital to community care is often incomplete, unclear and delayed. Especially hospital physicians (52%) and general practitioners (GPs; 63%) experience the quality of information exchanged from the hospital to the GP as poor. Coordination of care is often frustrated by a lack of care provider knowledge and collaboration. Hospital physicians (47%) and GPs (71%) feel that hospital physicians are often not sufficiently aware of the patient's home situation. Respectively, 59 and 81% experience that the GP is often not clearly informed about expected tasks and responsibilities at discharge.ConclusionsThis is the first study that provides a clear picture of the experiences and perceptions of stakeholders regarding handovers at hospital discharge. Lack of knowledge, understanding and interest between hospital and community care providers are important causes for ineffective and unsafe discharge. The study suggests that improvement efforts should be focused more on these aspects, as primary conditions for improving hospital discharge.

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