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“Out of sight, out of mind”: Housestaff perceptions of quality-limiting factors in discharge care at teaching hospitals


  • Disclosures: The Robert Wood Johnson Foundation Clinical Scholars program and US Department of Veterans Affairs provided funding support. Dr Horwitz is supported by the National Institute on Aging (K08 AG038336) and by the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program. No funding source had any role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. This paper was presented at the 2011 Annual Meeting of the Society of Hospital Medicine. The authors have declared they have no conflicts of interest for this study.



Improving hospital discharge has become a national priority for teaching hospitals, yet little is known about physician perspectives on factors limiting the quality of discharge care.


To describe the discharge process from the perspective of housestaff physicians, and to generate hypotheses about quality-limiting factors and key strategies for improvement.


Qualitative study with in-depth, in-person interviews with a diverse sample of 29 internal medicine housestaff, in 2010–2011, at 2 separate internal medicine training programs, including 7 different hospitals. We used the constant comparative method of qualitative analysis to explore the experiences and perceptions of factors affecting the quality of discharge care.


We identified 5 unifying themes describing factors perceived to limit the quality of discharge care: (1) competing priorities in the discharge process; (2) inadequate coordination within multidisciplinary discharge teams; (3) lack of standardization in discharge procedures; (4) poor patient and family communication; and (5) lack of postdischarge feedback and clinical responsibility.


Quality-limiting factors described by housestaff identified key processes for intervention. Establishment of clear standards for discharge procedures, including interdisciplinary teamwork, patient communication, and postdischarge continuity of care, may improve the quality of discharge care by housestaff at teaching hospitals. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine