This study, titled "Automated Indicator Feedback for Improving the Quality of Discharge Letters: A Cluster-Randomized Controlled Trial" (FIAQ-LS), aims to evaluate whether continuous real-time feedback to hospital teams can improve the quality of discharge letters. Discharge letters are critical for ensuring continuity of care and reducing adverse events by providing detailed information about a patient's hospital stay to both the patient and their primary care physician.
The study will be conducted at Grenoble Alpes University Hospital and involve 40 hospital services across three campuses. The trial design includes two parallel arms: an intervention group receiving monthly performance feedback through automated dashboards and a control group with no additional intervention. Services are randomized into these groups using a stratified cluster approach.
The primary objective is to assess whether this intervention increases the proportion of discharge letters validated on the day of discharge compared to usual care. Secondary objectives include evaluating patient satisfaction, rates of unplanned 30-day readmissions, and completeness of discharge letter content.
The study will include data from approximately 132,000 patient stays over two phases: a pre-implementation observational period (12 months) and an intervention phase (12 months). All data will be collected and analyzed anonymously, with findings expected to inform the broader implementation of quality improvement strategies in French hospitals.
Patients hospitalized for at least 24 hours in participating services.
Patients discharged alive directly from participating services.
Patients hospitalized for less than 24 hours.
Patients who died during hospitalization.
Stays in services not meeting inclusion criteria (e.g., psychiatry, long-term care, emergency services with rare direct discharges, or critical care units).
Parallel
Monthly Performance Feedback with Dashboards (Automated Audit and Feedback)
Other interventionHospital services in the intervention group will receive monthly automated dashboards that provide detailed performance metrics. These include: The proportion of patients with a discharge letter generated on the day of discharge, The proportion of discharge letters validated on the day of discharge, Median delays for generating discharge letters, Median delays for validating discharge letters. The dashboards are shared with all physicians, nurse managers, and secretarial staff in each service. A designated quality improvement officer is available to assist teams in interpreting the data and implementing organizational changes based on the feedback. The intervention uses real-time data extraction from the hospital's electronic health record system to generate these insights.
Proportion of Discharge Letters Generated on the Day of Discharge
The proportion of hospital stays where discharge letters are generated electronically on the same day as the patient's discharge. This measure evaluates the timeliness of generating discharge communication, a critical factor for continuity of care and patient engagement. Data will be extracted from the hospital's electronic health record system (EHR) and aggregated at the service level for analysis.
Proportion of Discharge Letters Validated on the Day of Discharge
The proportion of hospital stays where discharge letters are validated electronically on the day of discharge. This measure assesses the quality and timeliness of the validation process, ensuring that discharge letters are ready for patient handover and communication with primary care providers. Data will be extracted from the hospital's electronic health record system and analyzed at the service level.
Median Time to Generate Discharge Letters
The median time (in hours) from the patient's discharge to the generation of the discharge letter. This measure evaluates process efficiency and timeliness, critical for improving discharge workflows and patient communication. Data will be extracted from the hospital's electronic health record system.
Median Time to Validate Discharge Letters
The median time (in hours) from the generation of a discharge letter to its validation. This outcome assesses the efficiency of the validation process, a key step in finalizing discharge communication for patients and primary care providers.
Time from Patient Discharge to Electronic Submission of Discharge Letter to Primary Care Physicians
The median time (in days) from the patient's discharge to the electronic transmission of the discharge letter to the external primary care physician (e.g., general practitioner). This outcome assesses the timeliness of communication between hospital services and external care providers, a key factor in ensuring continuity of care after hospitalization.
Completeness of Required Fields in Discharge Letters
The proportion of discharge letters that include all mandatory fields as per national guidelines. These fields include patient identification, hospital stay dates, discharge summary, follow-up plan, and other regulatory elements. Completeness is critical to ensuring comprehensive communication for continuity of care.
Documentation of Organizational Changes in Intervention Services
Tracking and analysis of organizational adjustments reported by services in the intervention group in response to performance feedback. These changes will be documented through service logs and interviews, providing qualitative insights into the mechanisms driving performance improvement.
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