Abstract
Background: Discharge from acute mental health inpatient units is often a vulnerable period for patients. Multiple professionals and agencies are involved and processes and procedures are not standardized, often resulting in communication delays and co-ordination failures. Early and appropriate discharge planning and standardization of procedures could make inpatient care safer.Aim: To inform the development of a multi-component best practice guidance for discharge planning (including the 6 component SAFER patient flow bundle) to support safer patient transition from mental health hospitals to the community.Methods: Using the RAND/UCLA Appropriateness method, a panel of 10 professional stakeholders (psychiatrists, psychiatric nurses, clinical psychologists, pharmacists, academics, and policy makers) rated evidence-based statements. Six hundred and sixty-eight statements corresponding to 10 potential components of discharge planning best practice were rated on a 9-point integer scale for clarity, appropriateness and feasibility (median ≥ 7–9) using an online questionnaire then remote online face-to-face meetings.Results: Five of the six “SAFER” patient flow bundle components were appropriate and feasible for inpatient mental health. One component, “Early Flow,” was rated inappropriate as mental health settings require more flexibility. Overall, 285 statements were rated as appropriate and feasible. Forty-four statements were considered appropriate but not feasible to implement.Discussion: This consensus study has identified components of a best practice guidance/intervention for discharge planning for UK mental health settings. Although some components describe processes that already happen in everyday clinical interactions (i.e., review by a senior clinician), standardizing such processes could have important safety benefits alongside a tailored and timely approach to post-discharge care.
Highlights
Safer discharge and transition from inpatient care to the community is a key global concern, with the World Health Organization Third Patient Safety Challenge featuring care transition as one of three priorities for action [1]
This study used RAND/UCLA Appropriateness Method (RAM) methodology with key stakeholder groups to identify which components of an existing multicomponent discharge planning interventions/guidance are applicable and feasible within mental health settings
This included how exactly each intervention component should be operationalized, to improve best practice and support safer discharge of patients from mental health hospitals to the community and how the intervention would work on a practical level with 285 statements rated as appropriate and feasible
Summary
Safer discharge and transition from inpatient care to the community is a key global concern, with the World Health Organization Third Patient Safety Challenge featuring care transition as one of three priorities for action [1]. Transition from acute mental health inpatient units to the community care is especially risky because multiple professionals and agencies are involved making communication delays and co-ordination failures likely to occur. Such communication and co-ordination failures lead to traumatic experiences for patients, and several adverse outcomes including patient safety incidents at pre- and post-discharge [2, 3]. And appropriate discharge planning could make inpatient care safer and more person-centered, reduce unnecessary delays in hospital stays and contribute to a smoother adjustment of patients to the community after discharge [1, 4,5,6,7]. And appropriate discharge planning and standardization of procedures could make inpatient care safer
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