Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 25;22(1):1289.
doi: 10.1186/s12913-022-08644-5.

How to fall into a new routine: factors influencing the implementation of an admission and discharge programme in hospitals and general practices

Johanna Forstner #  1 , Nicola Litke #  2 , Aline Weis  2 , Cornelia Straßner  2 , Joachim Szecsenyi  2 , Michel Wensing  2
Affiliations

How to fall into a new routine: factors influencing the implementation of an admission and discharge programme in hospitals and general practices

Johanna Forstner et al. BMC Health Serv Res. .

Abstract

Introduction: The VESPEERA programme is a multifaceted programme to enhance information transfer between general practice and hospital across the process of hospital admission, stay and discharge. It was implemented in 7 hospitals and 72 general practices in Southern Germany. Uptake was heterogeneous and overall low. A process evaluation aimed at identifying factors associated with the implementation of the VESPEERA programme.

Methods: This was a qualitative study using semi-structured interviews in a purposeful sample of health workers in hospitals and general practices in the VESPEERA programme. Qualitative framework analysis using the Consolidated Framework for Implementation Research was performed and revealed the topic of previous and new routines to be protruding. Inductive content analysis was used for in-depth examination of stages in the process of staying in a previous or falling into a new routines.

Results: Thirty-six interviews were conducted with 17 participants from general practices and 19 participants from hospitals. The interviewees were in different stages of the implementation process at the time of the interviews. Four stages were identified: Stage 1,'Previous routine and tension for change', describes the situation in which VESPEERA was to be implemented and the factors leading to the decision to participate. In stage 2,'Adoption of the VESPEERA programme', factors that influenced whether individuals decided to employ the innovation are relevant. Stage 3 comprises 'Determinants for falling into and staying in the new VESPEERA-routine' relates to actual implementation and finally, in stage 4, the participants reflect on the success of the implementation.

Conclusions: The individuals and organisations participating in the VESPEERA programme were in different stages of a process from the previous to the new routine, which were characterised by different determinants of implementation. In all stages, organisational factors were main determinants of implementation, but different factors emerged in different implementation stages. A low distinction between decision-making power and executive, as well as available resources, were beneficial for the implementation of the innovation.

Trial registration: DRKS00015183 on DRKS / Universal Trial Number (UTN): U1111-1218-0992.

Keywords: Admission management; Discharge management; General practice; Hospital; Implementation; Middle management; Routine.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Components of the VESPEERA programme [21]
Fig. 2
Fig. 2
Stages of the implementation process and its’ determinants of the VESPEERA programme
See this image and copyright information in PMC

References

    1. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297:831–841. doi: 10.1001/jama.297.8.831. - DOI - PubMed
    1. Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J GEN INTERN MED. 2003;18:646–651. doi: 10.1046/j.1525-1497.2003.20722.x. - DOI - PMC - PubMed
    1. Straßner C, Hoffmann M, Forstner J, Roth C, Szecsenyi J, Wensing M. Interventions to Improve Hospital Admission and Discharge Management: An Umbrella Review of Systematic Reviews. Qual Manag Health Care. 2020;29:67–75. doi: 10.1097/QMH.0000000000000244. - DOI - PubMed
    1. Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011;155:520–528. doi: 10.7326/0003-4819-155-8-201110180-00008. - DOI - PubMed
    1. Hesselink G, Schoonhoven L, Barach P, Spijker A, Gademan P, Kalkman C, et al. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2012;157:417–428. doi: 10.7326/0003-4819-157-6-201209180-00006. - DOI - PubMed

LinkOut - more resources