Discharge Planning Activities Research Articles

Discharge planning practice for patients with colorectal cancer in Thailand

Background & Aim: Nurses play a vital role in discharge planning, especially for patients with colorectal cancer who require complex post-treatment care. However, there is a limited understanding of nurses' discharge planning practice in oncology settings. This study aimed to examine current discharge planning practices for patients with colorectal cancer among oncology nurses in Thailand and associated factors.
 Methods & Materials: A cross-sectional survey study was conducted between October and November 2020. Oncology nurses involved in colorectal cancer care were recruited across Thailand via Facebook and the Line application. A convenience and snowball sample of 206 nurses completed the online survey. Descriptive statistics, t-test, and one-way ANOVA were used for data analysis.
 Results: The discharge planning activity with the lowest mean score was related to sharing discharge planning summaries and/or care plans with other healthcare facilities (M = 3.00, SD= 1.32), followed by providing information about returning to work (M= 3.06, SD= 1.28), financial resources (M= 3.12, SD= 1.26), and disease (M= 3.13, SD= 1.25). Factors significantly associated with discharge planning practice included nursing education levels, specialty training in cancer care, and experience in colorectal cancer care.
 Conclusion: Despite the availability of discharge planning guidelines, Thai oncology nurses did not perform the full scope of discharge planning activities required for patients with colorectal cancer. Additional strategies, resources, and support systems should be established to facilitate nurses' performance of the full scope of their discharge planning practice in oncology settings. Moreover, our results suggest the need for additional education and training in the form of enhanced curriculums and continuing education seminars addressing cancer care to advance nurses' discharge planning for patients with colorectal cancer.

Hospital organizational structure factors related to discharge planning activities for alcoholics by nurses in Japan.

Nurses play a significant role in providing discharge support for alcoholics. We aimed to explore the organizational structures of hospitals that are related to effective discharge planning activities provided by nurses. We conducted a cross-sectional survey of Japanese hospitals with psychiatric wards that accept alcoholics. The survey questionnaire was administered to one nurse per hospital from August to September 2019. The Discharge Planning Scale for Ward Nurses (DPWN) was used to assess the actual status of the hospital nurse teams' discharge planning activities. The DPWN consists of four subscales: subscale I, "collect information from patients and their families"; subscale II, "supports for decision-making for the patients and families"; subscale III, "utilization of social resources"; and subscale IV, "discharge guidance by cooperating with community support teams and multidisciplinary teams." From the valid responses of 116 hospitals, scores on subscale IV were significantly lower than scores on subscales I, II, and III, indicating that medical care guidance through multidisciplinary collaboration between hospitals and the community was inadequate. In addition, multiple regression analysis showed that "hospital management and administrators understanding about nurses' discharge support activities," and "planning discharge schedules, such as using clinical paths" were significantly and independently related to the total DPWN and each of subscale scores, regardless of the hospital's establishment body and size. "Multidisciplinary discharge support" was significantly related to subscale II. These findings have implications for the management of discharge planning activities provided by nurses for alcoholics through multidisciplinary collaboration.

179 WHAT MATTERS TO THE FRAIL OLDER PERSON CHANGES DURING COVID-19 AND SHOULD INFORM PATIENT CENTRED CHANGE

Background‘What Matters to You’(WMTY) is a routine question in the comprehensive geriatric assessment (CGA) of the frail older person. The aim was to categorise WMTY and investigate changes during COVID-19.MethodsWMTY, clinical frailty score (CFS), age, gender, vision and hearing impairment, malnutrition risk, modified Barthel Index (mBI), living alone status, 4AT and dementia screening results were prospectively entered onto MS Excel. Answers were retrospectively categorised and compared, pre-COVID-19 (April to June 2019) and during COVID-19 (April to June 2020). Descriptive statistics and MS Excel T-test were used for data analysis.ResultsThe mean CFS (5), age (82 years), male: female ratio (1:1.3), prevalence of visual and hearing impairment (20–30%) and malnutrition risk were similar (23%) in both groups mBI was non-significantly reduced by a 1 point average during COVID-19.Less patients lived alone during COVID-19 (p = 0.05). Positive delirium screen doubled (12% vs 26%) during COVID-19. Positive dementia screen doubled (10% vs 20%) during COVID-19.Themes in decreasing order were family, health, home, functional independence, pets, discharge plan, religion, work, social activities and other pre-COVID-19. Family and health accounted for 49% of responses.During COVID-19, the order changed to health, family and home, functional independence, work and discharge planning, pets, religion and social activities.There was a 50% increase in functional independence as a response, a 40% increase in home and a 58% decrease in family as a response.ConclusionCognitive vulnerability doubled during COVID-19. Nine themes were identified. WMTY themes shifted during COVID-19. Health become the most frequent response. Family became a less frequent response with less people living alone. Functional independence was more frequent reflecting the need for self-reliance during COVID-19. Home, where all COVID-19 life was lived, was expressed as WMTY by a greater number of respondents. Promotion of functional independence has been identified as a key driver for practice change.

Interprofessional discharge team communication and empathy in discharge planning activities: A narrative review

Poor communication is a main cause of poor discharge planning . Although empathic processes underlie communication competence, the extent to which discharge team empathy has been studied is unclear. This paper will summarize interventions that incorporate empathic processes for effective interprofessional team communication. Guided by the SANRA scale, this narrative review presents research (2013–2019) on interprofessional communication and empathy interventions during discharge planning activities. Database searches yielded 2357 abstracts; ten fulfilled inclusion criteria. Limited studies exist with diverse interventions (simulation, process observations, video-enhanced learning, or TeamSTEPPS) that were mostly atheoretical and quasi-experimental, and samples of pre- and post-licensure clinicians ranging in size from 7 to 132. Evidence suggests that there is benefit to engaging in team-based discharge planning simulation when that simulation includes content on roles, debriefing, exercises in self-reflection, and use of video-feedback. As guided by theory, further benefits can be gained by incorporating empathic processes into interprofessional communication interventions.

Care Progression: Care Management Alignment.

Care Progression: Care Management Alignment.

O11.7. DISCHARGE PLANNING PRACTICES AND FAMILY INVOLVEMENT IN TRANSITIONS TO OUTPATIENT CARE FOLLOWING DISCHARGE FROM HOSPITAL PSYCHIATRIC UNITS

BackgroundIndividuals with mood and psychotic disorders treated in hospital psychiatric units have high rates of discontinuing treatment following discharge, a time that poses substantial risks of serious and even life threatening adverse outcomes. Hospital provider care transition practices believed to improve transitions include communication with outpatient providers, scheduling timely appointments for outpatient follow-up care, forwarding case summaries to aftercare providers, and involving family or support persons in discharge planning. While these are standards of care, little is known about how often they are adequately delivered and their impact on post-discharge aftercare adherence.MethodsAs part of a larger project looking at over 30,000 hospital admissions of Medicaid patients with serious mental illness, this study examined hospital medical records for 217 admissions at two urban US hospitals. Trained raters reviewed records for evidence of inpatient providers completing discharge planning practices. Medicaid data were used to measure demographics and attendance of seven- and 30-day outpatient appointments.ResultsThe sample of 217 admissions was 51% male and 82% were adults, with discharge diagnoses including schizophrenia and related disorders (45%), bipolar disorders (28%) and depressive disorders (17%). The average length of stay was 14 ± 13 days with a median of nine days. The medical records showed evidence of inpatient providers communicating with outpatient providers 64% (n=139) of the time. There was evidence of an outpatient appointment scheduled within seven days of discharge for 81% (n=176) of the sample. A case summary was made available to the aftercare provider within one day of discharge for 66% (n=144) of the sample. Records showed that the inpatient team communicated with family members or support persons about the patient’s post-discharge treatment plan for 53% (n=114) of the sample, and 36% (n=79) attended a family meeting or therapy session. Rates of attending an aftercare behavioral health appointment were 55% (n=120) at seven days post-discharge and 80% (n=174) for 30 days.DiscussionThis study found varying rates of providers completing care transition practices. Only half of the sample had attended an aftercare appointment in the seven days post discharge, however the majority had attended an appointment by 30 days. Planned analyses will present demographic and clinical differences among those who received discharge planning activities and had family involvement. We will examine predictors of attending follow-up care and report the effectiveness of discharge planning practices. Findings will help inform strategies to improve care-coordination and discharge planning for individuals with serious mental illnesses treated in psychiatric hospitals.

A qualitative study of professional and carer perceptions of the threats to safe hospital discharge for stroke and hip fracture patients in the English National Health Service.

BackgroundHospital discharge is a vulnerable transitional stage in patient care. This qualitative study investigated the views of healthcare professionals and patients about the threats to safe hospital discharge with aim of identifying contributory and latent factors. The study was undertaken in two regional health and social care systems in the English National Health Service, each comprising three acute hospitals, community and primary care providers and municipal social care services. The study focused on the threats to safe discharge for hip fracture and stroke patients as exemplars of complex care transitions.MethodsA qualitative study involving narrative interviews with 213 representative stakeholders and professionals involved in discharge planning and care transition activities. Narratives were analysed in line with ‘systems’ thinking to identify proximal (active) and distal (latent) factors, and the relationships between them.ResultsThree linked categories of commonly and consistently identified threat to safe discharge were identified: (1) ‘direct’ patient harms comprising falls, infection, sores and ulceration, medicines-related issues, and relapse; (2) proximal ‘contributing’ factors including completion of tests, assessment of patient, management of equipment and medicines, care plan, follow-up care and patient education; and distal ‘latent’ factors including discharge planning, referral processes, discharge timing, resources constraints, and organisational demands.ConclusionFrom the perspective of stakeholders, the study elaborates the relationship between patient harms and systemic factors in the context of hospital discharge. It supports the importance of communication and collaboration across occupational and organisational boundaries, but also the challenges to supporting such communication with the inherent complexity of the care system.

Nurses' discharge planning and risk assessment: behaviours, understanding and barriers

To examine nurses' discharge planning understanding, adherence and barriers. Discharge planning commenced at admission by nurses plays a key role in improving patient outcomes,but policies in place to maintain effective discharge planning are often not followed by nurses. This is a descriptive study. Nurses (n = 64) working in acute wards undertook a self-report survey of discharge planning understanding, adherence and barriers. Adherence to discharge planning policy is low (23%), despite a general awareness of the reduced quality of patient outcomes that may result. The most common barriers to discharge planning identified were lack of time and patient factors. Further contradictions occurred in that nurses understood the importance of discharge planning, yet did not comply with discharge planning policies. Nurses require additional encouragement and support in complying with discharge planning policies, and discharge planning policies should be adapted to better handle unpredictable illness trajectories. Completion of discharge planning is important for the safe transition of patients from one care setting to the next. Before a systematic approach to discharge planning can be implemented, a greater understanding of nurses' discharge planning practice in acute care wards is required. Greater incorporation of discharge planning activities into nurses' daily practice may also occur if nurses are involved in the development and implementation of the discharge processes and then provided with education and regular feedback on monthly audit results.

Expansion of discharge planning system in Japan: Comparison of results of a nationwide survey between 2001 and 2010

BackgroundIn response to the rapid aging of the population in Japan, many care systems have been created in quick succession. Establishment of discharge planning departments (DPDs) in hospitals is one of them. In this study, we compared the distribution and characteristics of DPDs and the characteristics of the hospitals that have DPDs between 2001 and 2010 in Japan.MethodsWe mailed a questionnaire about the characteristics of hospitals and existence and situation of DPDs to all general hospitals with 100 or more general beds in 2001 and in 2010.ResultsIn 2001, of the 3,268 hospitals queried, 1,568 (48.0%) responded and 1,357 (41.5%) were selected for data analysis. In 2010, among 2,600 hospitals, 940 hospitals (36.1%) responded and 913 (35.1%) met the inclusion criteria. The percentage of hospitals with DPDs increased from 30% to more than 70% between the two surveys. More departments were under the direct control of the hospital director and more physicians participated in discharge planning activities in 2010 than in 2001. In 2001, private hospitals and hospitals with an affiliated institution or agency tended to have a DPD; however, the relationship between these factors and the presence of a DPD had disappeared in 2010. Larger hospitals and hospitals with more nurses per patient tended to have a DPD both in 2001 and 2010.ConclusionsSince 2008, the establishment of a DPD has been directly connected to medical fees so hospital administrators might have recognized the DPD as a “necessary and paid for” department. Having a DPD was the majority’s policy in Japan, and we must recognize the importance of quality assurance through DPDs from now on, especially in small hospitals.

Commentary

International Journal of Therapy and RehabilitationVol. 19, No. 6 CommentariesCommentaryKylie JohnstonKylie JohnstonSearch for more papers by this authorKylie JohnstonPublished Online:29 Sep 2013https://doi.org/10.12968/ijtr.2012.19.6.342AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R et al. (2008) Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 371(9614): 725–35 Crossref, Google ScholarClemson L, Mackenzie L, Ballinger C, Close JCT, Cumming RG (2008) Environmental interventions to prevent falls in community dwelling older people: a meta-analysis of randomised controlled trials. J Aging Health 20 (8): 954–71 Crossref, Google ScholarGrimmer K, Moss J (2001) The development, validity and application of a new instrument to assess the quality of discharge planning activities from the community perspective. Int J Qual Health Care 13(2): 109–16 Crossref, Google ScholarJohnston K, Barras S, Grimmer-Somers K (2010) Relationship between pre-discharge occupational therapy home assessment and prevalence of post-discharge falls. J Eval Clin Pract 16(6): 1333–9 Crossref, Google ScholarTinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18): 1279–84 Crossref, Google Scholar FiguresReferencesRelatedDetails 1 June 2012Volume 19Issue 6ISSN (online): 1759-779X Metrics History Published online 29 September 2013 Published in print 1 June 2012 Information© MA Healthcare LimitedPDF download

Creating an agreed discharge: discharge planning for clients with high care needs

The purpose of this study was to develop a conceptual model of discharge planning by discharge planning nurses for clients returning home with high care needs. In Japan, discharge planning plays an important role in the smooth and timely discharge of clients from medical facilities. Discharge planning nurses often oversee such processes, especially for clients with high care needs. However, a conceptual model that guides discharge planning nurses during the discharge planning process is currently lacking. Qualitative. A constant comparative approach was used to collect and analyse data from semi-structured interviews conducted with 13 discharge planning nurses working at medical centres throughout Japan. Each discharge planning nurse described her discharge planning activities for a client with high care needs. 'Creating an agreed discharge' was a core category of the discharge planning process carried out by discharge planning nurses. The process consisted of: (1) developing a blueprint, (2) reaching an agreement, (3) materialising the agreed plan and (4) sending the client home. The discharge planning nurse starts by developing a blueprint of client/family life after discharge. The blueprint guides each discharge planning nurse thereafter throughout their various activities. She or he also strives to reach an agreement with the client/family regarding the discharge plan. Discharge planning nurse activities detailed here are based on the client/family's daily life, and adjustments to the plan are made within an agreeable range. Developing a blueprint, revising and refining it to establish an agreed discharge plan based on the client/family's situations and preferences and coming to an agreement for further revisions and the final plan were essential in the discharge planning process. A precise projection of the client's condition, community resource knowledge, estimating family care and understanding specific client/family thoughts on returning home were vital to a successful discharge planning process. These findings may be useful for the development of discharge planning guidelines.

Hospital discharge: recommendations for performance improvement for family carers of people with dementia

BACKGROUND; It is acknowledge that discharge planning benefits both consumers and hospitals. What is not widely understood is the experience that the family carer of a person with a dementia has and whether the hospitals meet their in-hospital and post-hospital needs. To explore whether metropolitan and rural hospital discharge practices meet the needs of the family carer of a person with dementia. Although this and other research indicates that a continuum of care model is beneficial to family caregivers, no evidence has been identified that family carers currently experience this type of quality planning. Family carers were often unaware of the existence of a hospital discharge plan and were rarely engaged in communication about the care of their family member with a dementia or prepared for discharge. CONCLUSION AND RECOMMENDATIONS; Discharge planning processes for family carers of people with dementia could be substantially improved. It is recommended that hospitals develop policy, process and procedures that take into account the family carer's needs, develop key performance indicators and adopt best practice standards that direct discharge planning activities and early engagement of the family carer in healthcare decisions. It is recommended that health professionals be educated on communication, consultation and needs of family carers.

Ethical Dilemmas Among Nurses as They Transition to Hospital Case Management

The purpose of this study was to describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute care setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice of case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

Heart Failure and Weight Gain Monitoring

Heart failure is one of the most common diagnoses of the elderly in the United States. The nursing literature has demonstrated that nursing interventions aimed at effective discharge planning and appropriate self-care activities can improve outcomes for patients hospitalized with heart failure. The purpose of this research was to identify, through retrospective medical record review, the discharge instruction related to self-weight monitoring provided to a sample of heart failure patients. The patients in the sample were 65 years and older with an ICD-9 diagnostic code of heart failure upon discharge from an acute care hospital in the Midwest. Results demonstrated the lack of nursing attentiveness to teaching self-monitoring weight gain to heart failure patients while hospitalized and the need for more comprehensive planning for appropriate discharge referrals. Suggestions are made for expanding documentation tools to improve nursing discharge planning and case management to ensure that the patient or caregiver is able to carry out self-care activities at home.

Current status of discharge planning activities and systems: National survey of discharge planning in Japan

AbstractAim: We investigated the current situation of discharge planning in Japan and the variables related to the implementation of discharge planning.Methods: A questionnaire was mailed to 3268 general hospitals in 2001; 1359 hospitals were used as the subjects of analysis.Results: The majority of the hospitals experienced problems in terms of patients’ discharge (1313 or 96.6%). More than 90% of the hospitals described discharge planning activities. The most common professions involving discharge planning were ward nursing staff and physicians, and only 29.4% hospitals reported that a discharge planning department was established in their hospitals. More hospitals with these departments implemented almost all activities of discharge planning compared with hospitals without such departments. Implementation of discharge planning was also related to hospital size, affiliated institutions, implementation of home visits by medical staff, and nurse/patient ratios.Conclusion: This survey showed a high implementation rate of discharge planning activities but that departments for discharge planning have not been widely adopted. It is recommended that such departments should be established or that staff should be allocated to carry out discharge planning in order to assure the continuity of quality care for patients as they move among care settings.

Discharge Planning and Social Work Practice

ABSTRACT Current health care practice discharge planning has emerged as a major professional function in hospital settings. To examine the tasks involved in discharge planning and how frequently they are being performed, 124 Alabama hospitals were contacted with a 72% response rate. Of the 178 surveys returned by discharge planners the core tasks were identified and ranked in terms of performance frequency. The results revealed that the tasks performed typically resembled that of generalist social workers. When specialization occurred, it was related to the populations served and not the specialized tasks or methods utilized. From this data recommendations are made for linking advanced generalist social work practice to discharge planning activities.

The development, validity and application of a new instrument to assess the quality of discharge planning activities from the community perspective

To describe the development, validity and application of a new instrument (PREPARED) for obtaining feedback from community consumers of discharge planning activities. Iterative qualitative and quantitative investigations. The community catchment area of a metropolitan Australian tertiary public hospital. Patients aged over 65 years, with a range of conditions, recently discharged from hospital, their carers, and hospital nursing staff. PREPARED was constructed from interviews with patients, carers and hospital staff. It was trialed and modified to ensure sensitive measurement of key attributes of discharge planning process and outcome. This paper explores the patient and carer versions of PREPARED. Data items were reduced to domains of key questions by factor analysis. Instrument performance was assessed by correlation of process and outcome measures, by comparing PREPARED responses with subsequent unstructured interview data, and by testing whether PREPARED responses were independent of health-related quality of life at the time of survey. Four key process domains were identified: information exchange (community services and equipment), medication management, preparation for coping after discharge and control of discharge circumstances. Outcome was measured as overall satisfaction with discharge, whether equipment and community service needs had been met, use of health services and health related costs post-discharge. The instrument performed well when compared with interview data, the process and outcome domains were largely independent of each other, as were responses to PREPARED and SF-36. PREPARED offers a comprehensive way of closing the quality improvement loop, by providing information from the community perspective on the quality of planning for discharge from the acute hospital setting.

The Construction of a Research Model on Post-Discharge Problems Based on a Review of the Literature 1990-1995

ABSTRACT Based on a review of the research literature on post-discharge problems published between 1990-1995, a model is constructed for future research. Hereto a two step theory synthesis method was used. Main problematic areas after discharge are a decreased functional, health, emotional and social status. Limitations or problems in these areas are influenced by patient-related and care-related factors and by the social network of the patient. Both outcome areas after discharge and the different influencing factors seem to be strongly interrelated. Some studies show favourable results from discharge planning activities. However, there is a great lack of empirical and controlled research.

Staff perceptions of discharge planning: a challenge for quality improvement.

One hundred staff in three acute care public hospitals were asked about their perceptions of successes and failures of their discharge planning activities. The intention was to highlight ways in which the quality of discharge planning could be improved within the acute hospital setting. Generally staff described failures more commonly than successes, with a number of key failures being identified, including problems associated with vacating beds, lack of appropriate staff, patients and career education about discharge activities, general process issues, problems associated with community service provision and patients who are difficult to discharge. Staff identified the lack of feedback on the outcome of their efforts as a source of frustration and a barrier to improving discharge planning activities. The challenges for improving the quality of discharge planning in the acute hospital setting would appear to be in establishing appropriate structures and processes that promote interaction between staff, patients and community providers, and provide incentives for behavioural change.

In search of the missing linkages: continuity of care in U.S. jails

Persons with symptoms of acute mental illnesses present problems for jail management. Jails have a constitutional duty to provide psychiatric services to all persons in need of such care. However, mental health resources are frequently insufficient to meet the many needs of persons with mental illnesses in jails, and are often inaccessible to those released to the community. This study focuses on the experiences of a cohort of detainees (n = 379) with mental illnesses who have been incarcerated in seven U.S. jails. Data gathered include criminal and demographic characteristics, mental health services received by the detainees in jail, discharge planning activities by jail staff, and community-based outcomes after release. This is primarily a descriptive study depicting typical experiences and processes related to detainees with mental illnesses. The goal is to provide information to support more detailed studies on the effectiveness of mental health-criminal justice linkages.