Marsall, M., Hornung, T., Bäuerle, A., & Weigl, M. (2024). Quality of care transition, patient safety incidents, and patients’ health status: A structural equation model on the complexity of the discharge process. BMC Health Services Research, 24(1). https://doi.org/10.1186/s12913-024-11047-3
The current research uses a structural equation modeling methodology to assess the relationship between the Care Transitions Measure (CTM) as a patient-reported experience measure with unplanned readmissions, medication complications, and postdischarge self-rated physical and mental health (Marsall et al., 2024). The article explains the CTM subscales management preparations, critical understanding care plan, and preferences, significance, and models the combined effects of these with age, length of stay, and exposure to intensive care. In the study, more favorable net quality of care transitions are more likely to forecast a decrease in medication complications and a patient-reported improvement in health, but not readmissions (Marsall et al., 2024). This emphasizes how quality improvement in discharge reduces the number of medication safety events and keeps patients healthy, which gives nurses the evidence to focus on discharge communication that prioritizes medication safety reconciliation and patient plans. To implement, nurses can utilize CTM as an evaluative PREM in local audits, use the study findings to support bundled discharge interventions, including medication reconciliation, teach back, and written individualized care plans in discharge support of older patients or patients who have recently been in intensive care. The study justifies the development of multi-component discharge bundles instead of using one action individually.
Keller, S. C., Salinas, A., Gürses, A. P., Levering, M., Hohl, D., Hirsch, D., Grimes, M., Ziemba, K., & Cosgrove, S. E. (2022). Implementing a toolkit to improve the education of patients on home-based outpatient parenteral antimicrobial therapy (OPAT). Joint Commission Journal on Quality and Patient Safety, 48(9), 468–474. https://doi.org/10.1016/j.jcjq.2022.05.008
This implementation paper proposes a practical patient education toolkit of home-based OPAT that packages short and long checklists, a patient education form, training videos, the SASH cognitive mat, and a uniform training workflow provided by an assigned home infusion trainer (Keller et al., 2022). The article presents mixed methods assessment data indicating that patients are highly satisfied with using videos and would prefer to use short checklists. The toolkit specifically targets the identified categories of gaps in discharge safety that are likely to cause postdischarge catheter and medication complications: hasty instruction, mismatched messages, and inadequate clinical practice. The assessment indicates that using visual aids and brief cognitive checklists enhances patient comfort and trust, which underpins the nurse's interventions to minimize adverse postdischarge events. The toolkit can be integrated into the OPAT discharge processes, where nurses can assign trained staff to lead bedside instruction using videos as a reinforcement tool through the use of teach back using the SASH mat as a cognitive aid and to issue short take-home checklists to use as a reference. This mode is suitable when patients will be self-managing complex therapies at home or whenever variability in patient education is suspected, and can be modified to teletraining when caregivers are not available.
Hartch, C. E., Dietrich, M. S., & Stolldorf, D. P. (2023). Effect of a medication adherence mobile phone app on medically underserved patients with chronic illness: Preliminary efficacy study. JMIR Formative Research, 7(1), e50579. https://doi.org/10.2196/50579
This single-arm pilot study aims to evaluate the medically underserved adult patients with the publicly available Medisafe medication adherence app and measure change at two weeks using the validated self-efficacy and adherence scales SEAMS and ARMS (Hartch et al., 2023). The paper records app features: reminders, adherence tracking, and optional social support, and reports a statistically significant increase in medication self-efficacy and a positive trend in adherence. The analysis demonstrates that a cheap or free commercially accessible app can increase patient confidence in using medications when and where appropriate and assist clinicians with forgetfulness, which is frequently a primary factor leading to nonadherence and postdischarge morbidity. The app provides a scalable tool to nurses to support self-management education and provide follow-up beyond the visit to the clinic. To help patients become familiar with the app, nurses may install the app with patients in the clinic or during discharge education, enter medication lists, confirm dosing, teach how to mark doses, invite a caregiver as a Medfriend, and do short follow-up calls to troubleshoot. The approach primarily applies to patients whose nonadherence is not intentional and who own smartphones, as well as to resource-restricted clinics interested in low-cost adherence supports; however, it can and should be combined with literature-friendly instructions where necessary.
Stanford, V., Leedham-Green, K., Clack, A., Parslow-Williams, S., Ratnappuli, A., & Mortimer, F. (2025). Strategies for implementing Sustainability in quality improvement (SusQI) education: Educator perspectives. BMJ Open Quality, 14(2), e003055. https://doi.org/10.1136/bmjoq-2024-003055
This qualitative research of the SusQI Beacon Site describes the open-access SusQI toolkit and educational scaffolding that contains ready-to-use presentations, workshop plans, case studies, project templates, and measurement tools to connect clinical value and environmental and financial co-benefits (Stanford et al., 2025). The paper summarizes the practical implementation steps and real-world examples across several sites. SusQI views quality improvement in a triple bottom line perspective to enable nurses to learn how to create initiatives that enhance patient outcomes, minimize waste and cost, and thus gain wider stakeholders' support. The toolkit provides approaches like process mapping, value chain analysis, and PDSA cycles that nurses can use to redesign discharge or medication processes to achieve safety and sustainability benefits. Nurse educators and unit leaders may utilize SusQI resources to educate staff on project-based QI run supported SusQI projects, measure clinical and environmental outcomes, and report co-benefits to leadership. This is particularly suitable where the institutions hope to match quality improvement with sustainability goals and where the uptake of the project requires the project to demonstrate various forms of value.