Do hospital size, location, and teaching status matter? Role of context in the use of evidence-based discharge practices

Background: In the manufacturing and service-sector industries, organizational characteristics associated with the use of innovation are well studied. This same study has not been applied to hospitals. The objective of this study was to find out whether size, location or teaching status have a relationship to the use of evidence-based hospital discharge practices. These practices were defined by Project RED (Re-Engineered Discharge), a set of practices which have been significantly associated with improved patient and hospital outcomes. Methods: A survey measuring the use of evidence-based discharge practices, based on Project RED, was administered to all 143 acute care hospitals in Ontario, Canada and 79 hospitals responded (55% participation rate). Multiple regression analysis was used to examine the relationship between survey score and the hospitals' location, size, and teaching status. Results: This study found that smaller hospitals in rural locations had significantly greater use of evidence-based discharge practices. Teaching status was not found to be significantly related to the use of these practices. Conclusion: There is a need to investigate how the characteristics of size and location influence the uptake of evidence-based practices. Smaller hospitals may benefit from fewer levels of management, and more direct communication between staff, physicians, and managers.