Outpatient discharge management model: a strategy to promote continuity of care.
Daniele Cristina Dos Reis Bobrowec, Elizabeth Bernardino, Gisele Knop Aued and 5 others
PMID 41919815WHAT IT FOUND
Nurses and physicians at a Brazilian teaching hospital described barriers to sending chronic patients back to primary care, including poor communication and unclear criteria.
They helped design a discharge model where a nurse coordinates the transition, but the model's impact on patient outcomes has not yet been tested.
Key findings
01Participants identified interpersonal communication, lack of discharge criteria, and network weaknesses as the main barriers to safe outpatient discharge.
02The proposed model positions a clinical nurse as the central link between hospital and primary care to ensure continuity.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only professionals from a single teaching hospital in Brazil, so the findings may not apply to other settings. The participants were healthcare staff, not patients, so patient experiences of discharge were not directly assessed. The proposed model has not yet been implemented or tested for effectiveness in real-world practice. Convenience sampling was used, which may introduce bias.
The easy way to misread this
Do not assume this discharge model improves patient health or reduces readmissions. The study describes the development and validation of a framework by staff, but it does not report any clinical outcomes or effectiveness data.