Leaving the hospital can be overwhelming, especially when patients are unsure about their next steps or who to contact with concerns. Clear communication at discharge is critical to patient well-being, yet many individuals report feeling unprepared when transitioning home. Recognizing this challenge, Lakeridge Health launched a strategic initiative to improve how patients receive and understand post-hospital care instructions.
Prioritizing Patient Experience
Lakeridge Health, one of Ontario's largest integrated health systems, made patient experience a key focus in its 2024/2025 Annual Business Plan. A crucial metric in this plan is the question: “Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?" This metric is also part of the Corporate Scorecard, reinforcing its importance across all levels of the organization.
“We are in the business of caring for people, and the voice of those we support is the driving force behind this meaningful work," says Annette Down, Director, Quality, Risk, and Person-Centred Care at Lakeridge Health.
By analyzing thousands of patient feedback surveys, Lakeridge Health identified common concerns and areas for improvement. A key theme that emerged was patient frustration over unclear discharge instructions and uncertainty about follow-up care. To address these issues, the hospital implemented several targeted initiatives aimed at ensuring patients and their families have the information they need for a smooth and safe transition home.
Key Initiatives to Improve Discharge Communication
Lakeridge Health adopted a multi-faceted approach to enhance the discharge experience and patient satisfaction. Here's how:
1. Enhancing After Visit Summaries (AVS)
A major improvement involved expanding the use of After Visit Summaries (AVS) – personalized documents that outline key details about a patient's hospital stay. These summaries provide clear instructions on medication, follow-up appointments, referrals, and when to seek emergency care.
Additionally, teams were trained on optimizing AVS usability by attaching educational materials, adjusting font sizes for accessibility, and offering multiple language options. These enhancements help ensure that all patients receive the necessary information in a format that works for them.
2. Increasing Access to MyChart Central East Ontario
Lakeridge Health promoted MyChart, a free and secure online portal that provides patients with access to their health records, including test results, appointment reminders, and discharge instructions. By actively helping patients enroll in MyChart before discharge, the hospital ensures that vital health information remains easily accessible long after they leave the hospital.
3. Strengthening Transparency Through Patient Feedback
To build trust and demonstrate accountability, Lakeridge Health improved how patient feedback is shared. Feedback from the patient experience surveys is publicly shared on the organization's website and through posters across hospital sites. This initiative reassures patients that their voices matter and that their feedback leads to real change.
One of the most common requests from patients was clearer discharge instructions. In response, the hospital refined its practices by standardizing MyChart usage, improving AVS distribution, and piloting a standardized unit orientation to better support care transitions.
4. Engaging Patient and Family Advisors (PFAs)
Lakeridge Health understands that the best way to improve the patient experience is by listening directly to patients and families. Patient and Family Advisors (PFAs) were actively involved in shaping discharge improvements through a working group and program councils. Their insights influenced several key initiatives, including a standardized discharge checklist and the co-design of an orientation program to help patients and essential partners-in-care better understand hospital processes.
5. Providing Targeted Support for Lower-Scoring Units
To ensure system-wide improvements, the hospital also focused on units with lower patient satisfaction scores related to discharge communication. By working closely with quality leads and frontline teams, Lakeridge Health developed tailored strategies to address specific challenges in these areas.
Looking Ahead: Setting a Higher Standard
Lakeridge Health is committed to continuous improvement and aims to achieve an 80 per cent patient satisfaction target for discharge communication in the 2025/2026 fiscal year. This goal will be met through ongoing collaboration with PFAs, hospital staff, and physicians, and via innovative solutions that enhance patient education and follow-up care.
By embedding discharge communication improvements into its Quality Improvement Plan and Corporate Scorecard, Lakeridge Health is setting a new standard for patient care. Its focus on clear communication ensures that patients leave the hospital with the knowledge and confidence they need to manage their health effectively at home, ultimately leading to better health outcomes and greater patient satisfaction.