ORIGINAL RESEARCH

Development of a Checklist of Safe Discharge Practices

for Hospital Patients
Christine Soong, MD1*, Stacey Daub, MBA2, Joseph Lee, MD, MCISc3, Cynthia Majewski4, Emily Musing, RPh, BScPhm, MHSc5,
Peter Nord, MD6, Roy Wyman, MD6, G. Ross Baker, PhD7, Nick Zacharopoulos, BA, BEd8, Chaim M. Bell, MD, PhD1

1
Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada; 2Toronto Central Community Care Access Centre, Toronto,
Ontario, Canada; 3Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; 4Quality Healthcare Network, Toronto, Ontario,
Canada; 5Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; 6Department of Family and Community Medicine, University
of Toronto, Toronto, Ontario, Canada; 7Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;
8
Ontario Public Service, Toronto, Ontario, Canada.

BACKGROUND: Discharge from hospital can be a vulnera- and patient-centered care transitions. A discharge-checklist
ble period for patients. Multifaceted “discharge bundles” tool was created to facilitate safe discharge from hospital.
facilitate care transitions and possibly decrease adverse
RESULTS: The final checklist describes the processes
outcomes. We describe a structured approach to discharge
necessary for a safe and optimal discharge and recom-
planning, starting from admission and proceeding through
mended timeline of when to complete each step, starting from
discharge, using a standardized checklist of tasks to be per-
the first day of admission. The checklist domains include (1)
formed for each hospitalization day.
indication for hospitalization, (2) primary care, (3) medication
safety, (4) follow-up plans, (5) home-care referral, (6) communi-
OBJECTIVE: To create an evidence-based checklist of safe
cation with outpatient providers, and (7) patient education.
discharge practices for hospital patients.
CONCLUSIONS: The Checklist of Safe Discharge Practices
METHODS: In the province of Ontario, the Ministry of Health for Hospital Patients summarizes the sequence of events
and Long-Term Care convened a panel of expert members that need to be completed throughout a typical hospitaliza-
from multiple disciplines and across several healthcare tion. Standardizing discharge planning and initiating proc-
sectors. The panel conducted a systematic search of the esses early on in a patient’s hospital stay may ensure a safe
literature and used a structured approach to review evi- transition home. Journal of Hospital Medicine 2013;8:444–
dence-based practices that ensure efficient, effective, safe, 449. VC 2013 Society of Hospital Medicine.

The transition from hospital to home can expose facilities with high rates of readmissions.11 Thus,
patients to adverse events during the postdischarge improving care transitions and thereby reducing
period.1,2 Deficits in communication at hospital avoidable readmissions are now priorities in many
discharge are common,3 and accurate information on jurisdictions in the United States. There is a similar
important hospital events is often inadequately trans- focus on readmission rates in the province of On-
mitted to outpatient providers, which may adversely tario.12 The Ontario Ministry of Health and Long-
affect patient outcomes.4–6 “Discharge bundles” Term Care convened an expert advisory panel with a
(multifaceted interventions including patient educa- mandate to provide guidance on evidence-based prac-
tion, structured discharge planning, medication recon- tices that ensure efficient, effective, safe, and patient-
ciliation, and follow-up visits or phone calls) are centered care transitions.13 The objective of this study
strategies that provide support to patients returning is to describe a structured panel approach to safe dis-
home and facilitate transfer of information to pri- charge practices, including a checklist of a recom-
mary-care providers (PCPs).7–9 These interventions mended sequence of steps that can be followed
collectively may improve patient satisfaction and pos- throughout the hospital stay. This tool can aid efforts
sibly reduce rehospitalization.10 to optimize patient discharge from the hospital and
Beginning in 2012, the Centers for Medicare and improve outcomes.
Medicaid Services will be reducing payments to
METHODS
Literature Review
*Address for correspondence and reprint requests: Christine Soong,
MD, Division of General Internal Medicine, Mount Sinai Hospital, 600 Uni-
The research team reviewed the literature to determine
versity Ave, Room 428, Toronto, ON M5G 1X5 Canada; Telephone: 416– the nature and format of the core information to be
586-4800; Fax: 647-776-3148; E-mail: csoong@[Link] contained in a discharge checklist for hospitalized
Additional Supporting Information may be found in the online version of patients. We searched Medline (through January
this article.
2011) for relevant articles. We used combined Medi-
Received: November 26, 2012; Revised: January 29, 2013; Accepted: cal Subject Headings and keywords using “patient
February 10, 2013
2013 Society of Hospital Medicine DOI 10.1002/jhm.2032 discharge,” “transition,” and “medication recon-
Published online in Wiley Online Library ([Link]). ciliation.” Bibliographies of all relevant articles were

444 An Official Publication of the Society of Hospital Medicine Journal of Hospital Medicine Vol 8 | No 8 | August 2013
 Checklist of Safe Discharge Practices | Soong et al

FIG. 1. The checklist-development process.

reviewed to identify additional studies. In addition, months, from January 2011 to March 2011. At the
we conducted a focused study of select resources, such first meeting, the panel reviewed existing toolkits
as the systematic review examining interventions to and evidence-based recommendations around best
reduce rehospitalization by Hansen and colleagues,10 discharge practices. During the meeting, panel mem-
the Transitional Care Initiative for heart failure bers were assigned to 1 of 6 groups (based on spe-
patients,14 the Care Transitions Intervention,15 Project cialty area) and instructed to review toolkits and
RED (Re-Engineered Hospital Discharge),7 Project literature using a context-specific lens (primary care,
BOOST (Better Outcomes by Optimizing Safe Transi- home care, follow-up plans, communication to pro-
tions),16 and The King’s Fund report on avoiding hos- viders and caregivers, medication, and education).
pital admissions.17 Available toolkit resources The goal of this exercise was to ensure that ele-
including those developed by the Commonwealth ments necessary for a successful discharge were
Fund in partnership with the Institute for Healthcare viewed through the perspectives of interprofessional
Improvement,18 the World Health Organization,19 groups involved in the care of a patient. For exam-
and the Safer Healthcare Now!20 were examined in ple, PCPs in group 1 were asked to consider an
detail. ideal discharge from the perspective of primary
care. Following the meeting, each group communi-
Consultation With Experts cated via e-mail to generate a list of evidence-based
The panel was composed of expert members from items necessary for a safe discharge within the con-
multiple disciplines and across several healthcare sec- text of the group’s assigned lens. Every group
tors, including PCPs, hospitalists, rehabilitation clini- reached consensus on items specific to its context. A
cians, nurses, researchers, pharmacists, academics, and preliminary draft checklist was produced based on
hospital administrators. The aim was to create a dis- input from all groups. The checklist was created
charge checklist to aid in transition planning based on using recommended human-factors engineering con-
best practices. cepts.21 The second meeting provided the opportu-
nity for individual comments and feedback on the
Checklist-Development Process draft checklist. Three cycles of checklist revision fol-
An improvement consultant (N.Z.) facilitated the lowed by comments and feedback were conducted
process (Figure 1). The results of the literature after the meeting, through e-mail exchange. A final
review were circulated prior to the first meeting. meeting provided consensus of the panel on every
The panel met 3 times in person over a period of 3 element of the Safe Discharge Practices Checklist.

An Official Publication of the Society of Hospital Medicine Journal of Hospital Medicine Vol 8 | No 8 | August 2013 445
Soong et al | Checklist of Safe Discharge Practices

TABLE 1. Checklist of Safe Discharge Practices for Hospital Patients

Day of Subsequent Discharge Discharge
Admission Hospital Days Day Day 13

1. Hospital
a. Assess patient to see if hospitalization is still required. 冑 冑
2. Primary care
a. Identify and/or confirm patient has an active PCP; alert care team if no PCP and/or begin PCP search. 冑
b. Contact PCP and notify of patient’s admission, diagnosis, and predicted discharge date. 冑
c. Book postdischarge PCP follow-up appointment within 7–14 days of discharge (according to patient/caregiver availability and transportation needs). 冑
3. Medication safety
a. Develop BPMH and reconcile this to admission’s medication orders. 冑
b. Teach patient how to properly use discharge medications and how these relate to the medications patient was taking prior to admission. 冑 冑 冑
c. Reconcile discharge medication order/prescription with BPMH and medications prescribed while in hospital. 冑
4. Follow-up
a. Perform postdischarge follow-up phone call to patient (for patients with high LACE scores*). During call, ask: 冑
 Has patient received new meds (if any)?
 Has patient received home care?
 Remind patient of upcoming appointments.
 If necessary, schedule patient and caregiver to come back to facility for education and training.
b. If necessary, arrange outpatient investigations (laboratory, radiology, etc.). 冑 冑
c. If necessary, book specialty-clinic follow-up appointment. 冑 冑
5. Home care
a. Home-care agency shares information, where available, about patient’s existing community services. 冑 冑
b. Engage home-care agencies (eg, interdisciplinary rounds). 冑 冑 冑
c. If necessary, schedule postdischarge care. 冑 冑
6. Communication
a. Provide patient, community pharmacy, PCP, and formal caregiver (family, LTC, home-care agency) with copy of Discharge 冑
Summary Plan/Note and the Medication Reconciliation Form, and contact information of attending hospital physician and inpatient unit.
7. Patient education
a. Clinical team performs teach-back to patient.† 冑 冑 冑
b. Explain to patient how new medications relate to diagnosis. 冑 冑
c. Thoroughly explain discharge summary to patient (use teach-back if needed). 冑
d. Explain potential symptoms, what to expect while at home, and under what circumstances patient should visit ED. 冑
NOTE: Abbreviations: BPMH, best possible medication history; ED, emergency department; LTC, long-term care, PCP, primary care physician.
*LACE index is a score calculated based on 4 factors: (L) length of hospital stay, (A) acuity on admission, (C) comorbidity, and (E) ED visits. A score of 101 indicates high risk for readmission to hospital.
†
Teach-back is the process of explaining information to patients and asking them to restate the information to assess accuracy. The instructor then repeats the process until the patient demonstrates correct recall and
comprehension.

RESULTS of admission may seem premature, we felt there was

Evidence-based interventions pre-, post-, and bridging merit in addressing issues early. For example, patients
discharge were categorized into 7 domains: (1) indica- admitted with heart failure can benefit from daily
tion for hospitalization, (2) primary care, (3) medica- inpatient education around self-monitoring, diet, and
tion safety, (4) follow-up plans, (5) home-care lifestyle counseling.22
referral, (6) communication with outpatient providers, The literature review identified communication with
and (7) patient education (Table 1). The panel PCPs as an important focus to prevent adverse events
reached 100% agreement on the recommended time- when patients transition from hospital to home.3 The
line to implement elements of the discharge checklist. expert panel agreed on admission notification, follow-
Given the diverse interprofessional membership of the up appointment scheduling, and transfer of a high-
panel, it was felt that a daily reminder of tasks to be quality discharge summary to the patient’s PCP, such
performed would provide the best format and have as one described by Maslove and colleagues.23 For
the highest likelihood of engaging team members in example, summaries containing structured sections
patient care coordination. It was also felt that daily such as relevant inpatient provider contacts, diagno-
interdisciplinary (ie, bullet) rounds would serve as the ses, course in hospital, results of investigations
most appropriate venue to utilize the checklist tool. (including pending results), discharge instructions and
The panel chose daily reminders to perform patient follow-up, and medication reconciliation have been
education around medications and clinical care for recommended to improve communication to outpa-
several reasons. Daily teaching provides an opportu- tient providers.3 Use of validated scores such as the
nity to assess information carried over and accurate LACE index (a score calculated based on 4 factors:
understanding of treatment plans, as well as to review [L] length of hospital stay, [A] acuity on admission,
changes in care plans that may be evolving during a [C] comorbidity, and [E] emergency department visits)
hospitalization. Although education starting on day 1 to identify patients at high risk of readmission and

446 An Official Publication of the Society of Hospital Medicine Journal of Hospital Medicine Vol 8 | No 8 | August 2013
 Checklist of Safe Discharge Practices | Soong et al

targeting these individuals when arranging postdi- Hospital Patients that details the steps of events that
scharge follow-up is encouraged.24,25 Patients with need to be completed for every day of a typical hospi-
high LACE scores (10) would benefit from postdi- talization. The day of discharge is often a confusing
scharge follow-up phone calls within the first 3 days and chaotic time, with patients receiving an over-
of returning home. In addition, high-risk patients may whelming volume of information on their last day in
require an earlier follow-up appointment with the the hospital. We believe that discharge planning starts
PCP, and the panel supports attempts to arrange fol- from the day of admission with daily patient educa-
low-up within 7 days for at-risk individuals. For those tion and a coordinated interdisciplinary team
without a PCP, it was recommended that a search approach. The components of the discharge checklist
should be initiated to assist the patient in obtaining a should be completed throughout a patient’s hospitali-
PCP. zation to ensure a successful discharge and transmis-
Medication safety is a significant source of adverse sion of knowledge.
events for patients returning home from the hospi- Discharge checklists have been described previously.
tal.2,26–28 The discharge checklist provides prompts to Halasyamani and colleagues developed a checklist for
reconcile medications on admission and discharge, in elderly inpatients created through a process of litera-
addition to daily patient education on proper use of ture and peer review followed by a panel discussion at
medications. Formal medication reconciliation pro- the Society of Hospital Medicine Annual Meeting.34
grams should be tailored to the individual hospital’s The resultant tool described important data elements
own resources and requirements.29,30 necessary for a successful discharge and which proc-
Postdischarge care plays an important role in sup- esses were most appropriate to facilitate the transfer
porting the patient upon discharge and when part of a of information. This differs significantly from our dis-
multifaceted discharge plan can result in decreased charge checklist, which provides specific recommenda-
readmission rates and hospital utilization.7,9,15,31 The tions on methods and processes to effect a safe
panel incorporated these elements by recommending discharge in addition to an expected timeline of when
performing postdischarge phone calls, arranging out- to complete each step. Kripalani et al reviewed the lit-
patient follow-up if necessary, and coordinating erature for suggested methods of promoting effective
home-care services through local agencies. transitions of care at discharge, and their results are
To facilitate transfer of information, patients, care- consistent with those summarized in our discharge
givers, outpatient providers, and community pharma- checklist.29 In contrast to both efforts, our group was
cies are to be provided copies of a comprehensive multidisciplinary and had broad representation from
discharge summary, medication reconciliation, and the acute care, chronic care, home care, rehabilitation
contact information of the inpatient team under the medicine, and long-term care sectors, thereby incorpo-
category of “Communication.” Finally, as the teach- rating all possible aspects of the transition process.
back method is an effective tool to ensure patient Coordinating discharge care requires significant team-
understanding of their health issues, the panel recom- work; our tool extends beyond a checklist of tasks to
mended its use when educating patients on medication be performed, and rather serves as a platform to facil-
use, plan of care, and discharge instructions.32,33 itate interprofessional collaboration. In addition, this
Examples of scenarios where teach-back would be of checklist was designed to integrate discharge planning
benefit include changes in medications with a high into interprofessional care rounds occurring through-
risk of adverse events, such as warfarin or furosemide, out a hospital admission. As well, our paper follows
to ensure patients understand the dosing, frequency, an explicit and defined consensus process. Finally, our
and monitoring required; and self-management skills proposed tool better follows a recommended checklist
(eg, daily weights and dietary changes) in patients format.21
with heart failure. The discharge process occurring during a patient’s
Finally, the panel noted that it was important to hospitalization is a complex, multifaceted care-coordi-
link the checklist items with relevant measures, audit, nation plan that must begin on the first day of admis-
and feedback to determine associations between pro- sion. Often, transfer of important information and
cess and outcomes. The group avoided specific medication review take place only hours before a
detailed recommendations to allow each institution to patient leaves the hospital, a suboptimal time for
locally tailor appropriate process and outcome meas- patient education.28,35 Just as standardized treatment
ures to assess fidelity of each component of the protocols and care plans can improve outcomes,36 a
checklist. similar approach for discharge processes may facilitate
safe transition from hospital to home. Our discharge
DISCUSSION checklist prompts hospital providers to initiate steps
A standardized, evidence-based discharge process is necessary for a successful discharge while allowing for
critical to safe transitions for the hospitalized patient. local adaptation in how each element is performed.
We have used a consensus process of stakeholders to We suggest using the checklist during daily interpro-
develop a Checklist of Safe Discharge Practices for fessional team rounds to ensure each task is

An Official Publication of the Society of Hospital Medicine Journal of Hospital Medicine Vol 8 | No 8 | August 2013 447
Soong et al | Checklist of Safe Discharge Practices

completed, if appropriate. Institutions may consider 7. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital dis-
charge program to decrease rehospitalization: a randomized trial. Ann
measuring process measures such as adherence and Intern Med. 2009;150(3):178–187.
completion of checklist, audits of discharge summaries 8. Dedhia P, Kravet S, Bulger J, et al. A Quality improvement interven-
tion to facilitate the transition of older adults from three hospitals
for completion and transmission rates to PCPs (by fax back to their homes. J Am Geriatr Soc. 57(9):1540–1546.
or through health record departments), and documen- 9. Koehler BE, Richter KM, Youngblood L, et al. Reduction of 30-day
postdischarge hospital readmission or emergency department (ED)
tation of patient education or medication reconcilia- visit rates in high-risk elderly medical patients through delivery of a
tion. Example outcome measures, if feasible, include targeted care bundle. J Hosp Med. 2009;4(4):211–218.
10. Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interven-
Care Transitions Measure (CTM) scores, patient tions to reduce 30-day rehospitalization: a systematic review. Ann
satisfaction surveys, and readmission rates. Intern Med. 2011;155(8):520–528.
Several limitations of this study should be consid- 11. Centers for Medicare and Medicaid Services. Readmissions reduction
program. Available at: [Link]
ered. First, current literature on safe discharge prac- Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.
tices is limited by low study-design quality, with a [Link] September 5, 2012.
12. Ontario Ministry of Health and Long-Term Care. The Excellent Care
paucity of randomized controlled trials. However, a for All Act, 2010. Available at: [Link]
recent systematic review found that bundled discharge programs/ecfa/[Link]/. Accessed February 28, 2013.
13. Ontario Ministry of Health and Long-Term Care; Baker GR, ed.
interventions are likely to be most effective.10 Individ- Enhancing the Continuum of Care: Report of the Avoidable Hospitali-
ual items of the checklist may not have had an exten- zation Advisory Panel, November 2011. Available at: http://
[Link]/en/common/ministry/publications/reports/
sive evidence base; however, some of these suggested baker_2011/baker_2011.pdf. Accessed August 8, 2012.
elements (eg, contact home care) have clinical face 14. Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM,
Schwartz JS. Transitional care of older adults hospitalized with heart
validity. Second, the heterogeneity of interventions failure: a randomized, controlled trial [published correction appears
studied pose challenges in determining generalizable in J Am Geriatr Soc. 2004;52(7):1228]. J Am Geriatr Soc. 2004;
52(5):675–684.
best practices without considering local factors. To 15. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions inter-
mitigate this, we suggest adapting the checklist to vention: results of a randomized controlled trial. Arch Intern Med.
2006;166(17):1822–1828.
local contexts and resource availability. Third, the 16. Society of Hospital Medicine. Project BOOST: Better Outcomes by
checklist has not been tested. The next step of this Optimizing Safe Transitions. Available at: [Link]
[Link]/BOOST/. Accessed October 31, 2012.
project is to pilot checklist use through small-scale 17. The King’s Fund; Ham C, Imison C, Jennings M. Avoiding Hospital
Plan-Do-Study-Act (PDSA) cycles followed by large- Admissions: Lessons From Evidence and Experience. Available at:
[Link]
scale implementation. We plan to collect baseline, admissions-lessons-evidence. Published October 28, 2010. Accessed
process, and outcome measures before and after September 4, 2012.
implementation of the checklist at multiple institutions 18. Nielsen GA, Rutherford P, Taylor J, eds. How-To Guide: Creating an
Ideal Transition Home. Cambridge, MA: Institute for Healthcare
to determine utility. Improvement; 2009. Available at: [Link] or [Link]
Standardization of discharge practices is critical to [Link]/files/IHI_How_to_Guide_Creating_an_Ideal_Transition_
[Link]. Accessed August 8, 2012.
safe transitions and preventing avoidable admissions 19. World Health Organization. Action on Patient Safety—High 5s.
to hospital. Our discharge checklist is an expanded Available at: [Link]
tions/high5s/en/[Link]. Accessed October 29, 2012.
tool that provides explicit guidance for each day of 20. Safer Healthcare Now! Medication Reconciliation in Acute Care: Get-
hospitalization and can be adapted for any hospital ting Started Kit. Available at: [Link]
MedRec/Medrec_AC_English_GSK_V3.pdf. Accessed October 29,
admission to aid interdisciplinary efforts toward a suc- 2012.
cessful discharge. Future studies to evaluate the check- 21. US Agency for Healthcare Research and Quality. PSNet: Patient-
safety primers, checklists. Available at: [Link]
list in improving care-transition processes are required [Link]?primerID514. Accessed November 1, 2012.
to determine association with outcomes. 22. Anderson C, Deepak BV, Amoateng-Adjepong Y, Zarich S. Benefits of
comprehensive inpatient education and discharge planning combined
with outpatient support in elderly patients with congestive heart fail-
Disclosures ure. Congest Heart Fail. 2005;11(6):315–321.
Nothing to report. 23. Maslove DM, Leiter RE, Grimshaw J, et al. Electronic versus dictated
hospital discharge summaries: a randomized controlled trial. J Gen
Intern Med. 2009;24(9):995–1001.
References
24. Gruneir A, Dhalla IA, van Walraven C, et al. Unplanned readmissions
1. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The inci- after hospital discharge among patients identified as being at high risk
dence and severity of adverse events affecting patients after discharge for readmission using a validated predictive algorithm. Open Med.
from the hospital. Ann Intern Med. 2003;138(3):161–167. 2011;5(2):e104–e111.
2. Roy CL, Poon EG, Karson AS, et al. Patient safety concerns arising 25. Van Walraven C, Dhalla IA, Bell C, et al. Derivation and validation of
from test results that return after hospital discharge. Ann Intern Med. an index to predict early death or unplanned readmission after dis-
2005;143(2):121–128. charge from hospital to the community. CMAJ. 2010;182(6):551–
557.
3. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker
DW. Deficits in communication and information transfer between 26. Resar R. Will, ideas, and execution: their role in reducing adverse
hospital-based and primary care physicians: implications for patient medication events. J Pediatr. 2005;147(6):727–728.
safety and continuity of care. JAMA. 2007;297(8):831–841. 27. Kucukarslan SN, Peters M, Mlynarek M, Nafziger DA. Pharmacists
on rounding teams reduce preventable adverse drug events in
4. Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW. hospital general medicine units. Arch Intern Med. 2003;163(17):
“I wish I had seen this test result earlier!”: dissatisfaction with test 2014–2018.
result management systems in primary care. Arch Intern Med. 28. Schnipper JL, Kirwin JL, Cotugno MC, et al. Role of pharmacist
2004;164(20):2223–2228. counseling in preventing adverse drug events after hospitalization.
5. Coleman EA, Berenson RA. Lost in transition: challenges and oppor- Arch Intern Med. 2006;166(5):565–571.
tunities for improving the quality of transitional care. Ann Intern 29. Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effec-
Med. 2004;141(7):533–536. tive transitions of care at hospital discharge: a review of key issues for
6. Van Walraven C, Mamdani M, Fang J, Austin PC. Continuity of care hospitalists. J Hosp Med. 2007;2(5):314–323.
and patient outcomes after hospital discharge. J Gen Intern Med. 30. Fernandes O, Shojania KG. Medication reconciliation in the hospital.
2004;19(6):624–631. Healthc Q. 2012;15:42–49.

448 An Official Publication of the Society of Hospital Medicine Journal of Hospital Medicine Vol 8 | No 8 | August 2013
 Checklist of Safe Discharge Practices | Soong et al

31. Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly 34. Halasyamani L, Kripalani S, Coleman E, et al. Transition of care for
M. Comprehensive discharge planning for the hospitalized elderly: hospitalized elderly patients—development of a discharge checklist
a randomized clinical trial. Ann Intern Med. 1994;120(12):999– for hospitalists. J Hosp Med. 2006;1(6):354–360.
1006. 35. McPhee SJ, Frank DH, Lewis C, Bush DE, Smith CR. Influence of a
32. Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician “discharge interview” on patient knowledge, compliance, and func-
communication with diabetic patients who have low health literacy. tional status after hospitalization. Med Care. 1983;21(8):755–767.
Arch Intern Med. 2003;163(1):83–90. 36. Pearson SD, Kleefield SF, Soukop JR, Cook EF, Lee TH. Critical path-
33. Cegala DJ, Marinelli T, Post D. The effects of patient communication ways intervention to reduce length of hospital stay. Am J Med.
skills training on compliance. Arch Fam Med. 2000;9(1):57–64. 2001;110(3):175–180.

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