Barriers and Key Determinants to Optimize the Discharge from Inpatient Rehabilitation: A Saudi Perspective

Abstract

<h3>Research Objectives</h3> To explore the barriers and key determinants of an effective discharge process from the perspective of rehabilitation clinicians. <h3>Design</h3> A cross-sectional study. <h3>Setting</h3> Rehabilitation hospital in a tertiary care hospital in Riyadh, which is considered the largest governmental medical city in Saudi Arabia, is composed of four specialized hospitals and four specialized centers. <h3>Participants</h3> 121 rehabilitation staff, recruited through convenience sampling, completed surveys; 6 participants were excluded due to incomplete responses to 11 or more of the 65 questions. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> A newly developed questionnaire with 10-domains and 65-items was developed and used after validity and reliability testing. Exploratory factor analysis and principal component analysis were conducted resulting in a final questionnaire of 43-items in 7 components. <h3>Results</h3> Of the 115 included participants, the male-to-female ratio was 5:2; 47.8% were allied health professionals of diverse specialties, 10.4% were physiatrists, and 41.7% were rehabilitation nurses. 20% have a postgraduate degree, and 63.5% have more than five years of clinical experience. Forty-three items categories within seven components were identified as critical determinants of effective discharge. Within component 1, meetings with patients and family to address patients' goals and needs (r=0.400), weekly team meetings formulation of discharge plans (r=0.519), and display form (r=0.523), effective team dynamics (r=0.645), adequate patient and caregiver education and training (component 4, r=-0.457), and early identification of the discharge destination and disposition plan (component 5, r=-0.402) have been identified as critical determinants of effective discharge. In addition, all items of early identification and planning to overcome discharge barriers of component 7 were weakly correlated with effective discharge. Finally, barriers to effective discharge were demonstrated by the inverse relation between effective discharge and recurrent modification of rehabilitation program goals (component 2, r=-0.402), patient/family unrealistic expectations (component 3, r=-0.018), and multiple changes of the discharge date (component 6, r=-0.107). <h3>Conclusions</h3> This study demonstrated several key determinants and barriers that can improve the patient discharge from a Saudi rehabilitation setting. <h3>Author(s) Disclosures</h3> The authors declare that there is no conflict of interest.