Table 3

Representative quotes about theme 1, communication

Quote 1Patient 2“If were to state anything, it is all about expectations. Setting proper expectations. And I’m sitting there watching these doctors knowing that they are running a whole fleet of problems, not just mine … I’m on the train here and I am just going to wait my turn in line, so to speak. I knew that but ideally … what is the next step? … It would have been nice to know what the next step is, for the expectations. That’s all.”
Quote 2Patient 3“I don’t know. I had an overall feeling of disorganization at that point. Nobody came in and said, okay, well this is the specific order that we’re going to go in now to discharge you.”
Quote 3Patient 2“When I was discharged, I was to make an appointment with the outpatient trauma after 7 days. And I did that [but] I wasn’t really clear what I should do. … I [go to the appointment] and [the TACS NP] basically said, he took the stitches out. And I asked for, ‘I need more oxy codeine’ and so he gave me kind of an amount [indicating too little]. … I kind of ran out of meds the day that I could get an appointment with [my PCP]. And then she right away gave me enough pills, more than I actually need now. That transition, maybe someone should have said, ‘Immediately make an appointment with your internal medicine doctor because she is going to take over care.’ And I did have some needs as far as meds go. And the nurse [practitioner in the TACS clinic] was kind of like, his role was to take out the stitches. That was kind of like his deal, ‘and the wound looks ok, you’re gone.’ There is common sense in here too; I have some responsibility. Then I immediately made an appointment with my doctor. But I had to wait a week to see her because of her schedule. I could have seen any other doctor but wanted to see her. That could have been handled better.”
Quote 4Nurse practitioner 2“I would like to spend more time with my patient discharging them. … I think that we don’t spend enough time with our patients guiding them to the next step.”
Quote 5Nurse 2“I feel like some people are ready to just bull out of there with like, ‘Just give me whatever I need and I’m just going to run out pretty much.’”
Quote 6Nurse 1“It’s very… ‘Okay, I need to call this person. Okay, now I need to call that person.’ It’s just discombobulated. It’s very separated, and it’s a bit difficult to get everybody on one page.”
Quote 7Nurse 2“Yeah, but sometimes [the physicians and NPs] would be really great. I would touch base and they would tell me everything I need to know. And sometimes I would be paging them and you guys are so busy and everything you’re doing and just trying to get ahold of the team and seeing what this patient needs so we can discharge this patient successfully and also timely as well.”
Quote 8Attending 2“Sometimes people have spent the extra time and effort to actually write some more thought in there to actually make it a piece of communication for the future, but I think in general, we treat the discharge summary as a way to close the admission rather than as a bridge to a future visit or encounter. So I think there’s particular room for improvement there.”
Quote 9Nurse practitioner 1“I can remember a patient. It was not too long ago and he was complex. He had a gunshot wound to his abdomen and had a liver injury, had multiple surgeries, was in the hospital for a long time. And he needed to also follow-up with us as well as multiple other services. And I think that the information and the discharge summary just was really minimal. And so it made it really hard when he came to clinic to try to fish out and try to figure out who [else] he needed to see …”
  • NP, nurse practitioner; PCP, primary care physician; TACS, trauma and acute care surgery.