Discharge Planning Research Articles

Facilitating the transition from hospital to home after hip fracture surgery: a qualitative study from the HIP HELPER trial.

People post-hip fracture have reported experiences of fragmented care and poor discharge planning, therefore improvements in patient flow are required. This study reports the challenges people face during the discharge process and offers potential solutions for improving the transition from hospital to home from the perspectives of patients, carers, and health professionals. This was a qualitative study embedded within a multi-centre, feasibility randomised controlled trial (HIP HELPER). We undertook semi-structured interviews with 10 patient-carer dyads (10 people with hip fracture; 10 unpaid carers) and eight health professionals (four physiotherapists, two occupational therapists, one nurse and one physiotherapy researcher) between November 2021 and March 2022. Data were analysed using the principles of Framework Analysis. Participants identified challenges in the transition from hospital to home post-hip fracture surgery: ineffective communication, disjointed systems, untimely services and 'it's more than just the hip'. Possible solutions and insights to facilitate this transition included the need for reassurance, collaborative planning, and individualisation. The transition from hospital to home following hip fracture surgery can be a challenging experience for patients, and for friends and family who support them as carers, making them feel vulnerable, frustrated and uncertain. Enabling a coordinated, collaborative approach to discharge planning and early recovery provision is considered a positive approach to improving NHS care. ISRCTN13270387. Registered 29th October 2020.

Characteristics and Trajectory of Older Adults Supported by a Patient Navigator Program in a Hospital Setting: A Cohort Observational Study.

To improve transitions in care, a new patient navigation (PN) program was introduced to support older adults with complex care needs transition from hospital to home. The patient navigator is a community social worker embedded in the hospital's care teams. A cohort observational design was used to conduct the study by analysing the patient navigator's clinical notes and hospital's administrative data to describe the characteristics of patients, scope of the patient navigator's activities, and patient outcomes. Ninety patients were assigned to the patient navigator's caseload (November 2019-November 2021) in which the average age was 78.9 (range 55-95). The most frequent PN intervention types were referrals to community services (66%, n = 59) and discharge planning (61%, n = 55). The patient navigator supported 66% patients (n = 59) in returning home and provided follow-up care for 74 days (average). This study provides important insights into the patient navigator's role to guide decision makers in implementing PN programs for older adults in a hospital setting.

Initiating Prognostic Talk During Hospice Multidisciplinary Team Meetings: A Conversation Analytic Study.

Objective: Guidelines recommend that patients' prognoses should be discussed by the palliative care multidisciplinary team. However, there is a lack of evidence on how multidisciplinary teams carry out prognostic discussions, and especially how prognostic talk is initiated during team meetings. This study explored how prognostic talk is initiated and responded to during meetings of a hospice multidisciplinary team. Methods: Video-recordings of 24 inpatient multidisciplinary team meetings in a UK hospice were collected from May to December 2021. A total of 65 multidisciplinary team members participated in the meetings. Recordings were transcribed and analysed using Conversation Analysis. Results: Prognostic talk was initiated during multidisciplinary team members' patient case presentations. Case presentations followed a certain template, and prognoses could be initiated as responses to template items such as the patient's Phase of Illness and Karnofsky's Performance Status score and the patient's main diagnosis and issues. Prognoses also occurred as accounts for a lack of template item responses. Beyond the patient case presentation, prognostic talk was initiated in relation to discharge planning. Prognoses appeared with sequences of assessments that accounted for them. When a prognosis was provided, it received confirming minimal responses from other team members. Conclusions: Patients' prognoses were embedded into other care discussions during meetings of a hospice multidisciplinary team. These findings can be used to inform the development of clinical guidelines and interventions aiming at improving multidisciplinary team discussions around prognosis in the future.

HPB SO63 - A Closed-Loop Audit on Surgical Ward Round Documentation in a Tertiary Hospital

Abstract Background Surgical ward rounds play a pivotal role in overall patient outcome during surgical and perioperative care. Clear and comprehensive documentations are crucial in providing an accurate account of ward round activities. We aimed to assess the quality of hepatopancreatobiliary (HPB) ward round documentation and the impact of a HPB surgical ward round proforma on the quality of documentation. Method 50 medical notes were reviewed in a tertiary centre to determine if key components of ward round documentation such as the date, time, diagnosis, procedure, consultant, person documenting, information communicated to patient, observations, investigations and management plan were documented. A proforma for ward round documentation was introduced. A re-audit was performed to review the impact of a proforma on ward-round documentation. Results The time of ward round, relevant history, NEWS and management plan were recorded in more than 50% of medical notes. However, the diagnosis, consultant, person documenting, information communicated to patient, wound review, medication review, fluid balance, investigations, follow up and discharge plans were documented in less than 50% of medical notes. After the introduction of a proforma, the date and time of the surgical ward round were documented in 94% of medical notes. 84% had initials of the consultants leading ward-rounds and the person documenting. More than 80% notes included relevant examination, information communicated to patient, wound and medications review. Conclusion Surgical ward round proformas have a role in improving ward round documentation. Good record keeping is essential for continuity of care, optimising quality of care and ensuring patient safety.

Abstract 4138516: Effects of Serious Mental Illness on Transcatheter Aortic Valve Replacement (TAVR) Outcomes and Access

Introduction: Serious mental illness (SMI) is associated with higher risk of immediate procedural complications after transcatheter aortic valve replacement (TAVR), including myocardial infarction, major bleeding, and acute renal failure. There is limited data on the impact of SMI on in-hospital mortality and 30-day readmissions. We aimed to evaluate access to and outcomes after TAVR for patients with SMI compared to those without SMI. Methods: We performed a retrospective cohort study of adults aged ≥18 years who received TAVR with a primary diagnosis of aortic stenosis using the Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery and Services Database in FL, MD, VT, UT, and WI (2016-2019). SMI was defined using ICD-10 codes for schizophrenia spectrum, mood, or anxiety disorders. Primary outcomes include in-hospital mortality, 30-day readmission, length of stay, and routine discharge. The secondary outcome was access type (elective vs. urgent/emergent). Multivariable logistic and negative binomial regression models with adjustment for patient demographics, co-morbidities, and hospital characteristics were used to examine outcomes. Results: Of 21,905 patients who underwent TAVR for aortic stenosis, 2,954 (13.5%) patients had SMI. Overall, 16,762 (76.5%) of patients had elective procedures. Patients with SMI were more likely to be female (59% vs. 41%, p<0.001) and have 3+ co-morbidities (91% vs. 77%, p<0.001) but had similar income quartile distribution (p=0.18), home-to-hospital distance (p=0.09), and clinically similar hospital TAVR volume over the study period (435 vs. 430, p=0.01). After adjustment for potential confounders, access to and outcomes of TAVR differed significantly by SMI status (See Table). Conclusions: SMI patients had increased odds of emergent access to TAVR. After TAVR, SMI patients had longer length of stay and were less likely to be discharged to home. These findings suggest increased discharge planning may be required for patients with SMI after TAVR and highlight the need for additional investigation into barriers to elective TAVR in this vulnerable population.

Evaluate the Differential Effectiveness of the Case Management and Primary Nursing Models in the Implementation of Discharge Planning.

This study aims to compare the effectiveness of the case management model and the primary nursing care model by focusing on hospital stay length, readmission, follow-up resource utilisation and survival. To improve patient continuity of care, a discharge planning team has been established at the hospital to implement the service concept of long-term medical care. The team works with a multidisciplinary medical team to provide case management, which ensures high-quality patient care. Retrospective case-control study. This study collected data from the medical record information system database and the Ministry of Health and Welfare's care service management information system to explore medical and follow-up care utilisation of patients discharged between 2017 and 2018. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, with the checklist used to ensure transparent and complete reporting of the methodology and results. To ensure comparability between the case management model group and the primary nursing model group, propensity score matching was used. After matching, 660 individuals from the case management model group and 2876 individuals from the primary nursing model group were selected for further analysis. In this study, patients were primarily involved in the research as participants, providing data through their medical records for analysis. However, no direct involvement from the public or patients was used in the planning or design stages of the research. The study found that factors such as activities of daily living (ADL) score ≤ 60 points, catheterisation, poor chronic disease control and inadequate primary caregiver capacity can lead to longer hospitalisations. Males and patients with catheters have a higher risk of readmission within 30 days, and men, those aged ≥ 75 years, those with ADL score ≤ 60, catheterisation, pressure sores or unclean wounds, financial problems, insufficient primary caregiver capacity and those readmitted within 14 days after discharge had significantly increased mortality after discharge. Although the case management model group had higher hospitalisation days, they had lower readmission rates and higher survival rates than the primary nursing model group. Early consultation with the case manager for discharge planning can help patients to continue to receive care and utilise relevant resources after returning home. Identifying and addressing patient-specific factors can significantly improve patient outcomes by reducing hospitalizations and readmissions, and lowering mortality rates. The case management model is more effective than the primary nursing care model in reducing readmission rates and increasing survival rates. Early consultation with case managers for discharge planning is crucial to ensuring patient care continuity and resource utilization.

‘I just don’t want them to be my patient again’: an exploratory mixed-methods study examining provider home safety concerns for adolescents with acquired brain injuries in the US Midwest

ObjectiveAdolescents with acquired brain injuries are at risk for additional injuries after hospital discharge. We asked healthcare providers to identify and prioritise urgent hazards in the home setting for this...

Perioperative Management of Opioid-Tolerant Patients: A Comprehensive Guide

The perioperative management of opioid-tolerant patients presents significant challenges, necessitating a tailored approach to pain management and the prevention of opioid-related complications. This review discusses the essential aspects of preoperative assessment, intraoperative strategies, and postoperative care for opioid-tolerant patients. Emphasis is placed on the continuation of baseline opioid therapy, the use of multimodal analgesia, and the importance of individualized opioid dosing to achieve effective pain control while minimizing the risk of withdrawal, respiratory depression, and opioid-induced hyperalgesia. The role of a multidisciplinary team in optimizing patient outcomes and the necessity of thorough discharge planning and follow-up are also highlighted. By addressing these critical factors, healthcare providers can ensure safe and effective perioperative care for opioid-tolerant patients.

Family caregivers of people with a tracheostomy: (Dis)satisfaction with discharge planning

Family caregivers of people with a tracheostomy: (Dis)satisfaction with discharge planning

Development of the Ward Nurses' Perspective-taking of the Staff Receiving Discharged Patients Scale: An observational study of ward nurses.

Discharge planning involves coordinating between different care settings. Failed coordination can lead to delayed care at the facilities receiving discharged patients. Nurses who implement discharge planning must consider the circumstances of the staff receiving the discharged patients. This study aims to develop a nurses' perspective-taking scale for measuring the cognitive process of imagining a staff's situation when receiving discharged patients. An online survey was conducted from September to November 2021 with nurses in Japanese acute care hospitals, using a 20-item questionnaire based on interviews and a literature review. Item reduction was conducted based on inter-item correlations, item-total correlations, and exploratory factor analysis. Confirmatory factor analysis was performed. For the exploratory and confirmatory factor analysis, the samples were randomly split in half and tested. Cronbach's alpha, intraclass correlation coefficients, and correlation coefficients were calculated using both self-developed and pre-existing measures. The questionnaire was distributed to 1,289 individuals, and 416 valid responses were obtained. Item reduction and exploratory factor analysis resulted in a 10-item scale with two subscales, "imagine-other" (six items), which is imagining the other person's situation, and "imagine-self" (four items), which is imagining oneself in the other person's situation. The goodness-of-fit indices were as follows: comparative fit index, 0.95; root mean square error of approximation, 0.08; and standardized root mean squared residual, 0.06. Correlation coefficients with existing scales were 0.38, 0.57, and -0.33. Cronbach's alpha was 0.89, and the intraclass correlation coefficient was 0.54. The newly developed scale proved to be reliable, valid, and suitable for use. This scale can measure the degree of perspective-taking by nurses, which can improve collaboration between facilities and the effectiveness of discharge planning.

Teletherapy and Medication Management of Attention-Deficit/Hyperactivity Disorder with Co-occurring Internalizing Symptoms and Suicidality During the Pandemic.

Sam (he/him) is an 11-year-old cisgender white male with previous diagnoses of attention-deficit/hyperactivity disorder, anxiety, and major depressive disorder who was referred to an outpatient psychiatry clinic after hospitalization for suicidal ideation and agitation. Family history is significant for bipolar disorder, depression, anxiety, substance use/abuse, and suicidality. Sam started a trial of atomoxetine 10 mg po QAM in December 2019 due to increasing inattention in the backdrop of worsening anxiety. Sam received school-based counseling through his IEP, which Sam declined due to embarrassment from being pulled out of the classroom, and services were quickly discontinued. In January 2020, obsessive-compulsive symptoms emerged, specifically obsessions about cleanliness with related compulsions. He started biweekly cognitive behavioral therapy with an outpatient provider to target obsessive-compulsive disorder symptoms. Concomitantly, a developmental-behavioral pediatrician who diagnosed obsessive-compulsive disorder started Sam on fluoxetine 10 mg po QAM. Atomoxetine was also increased to 25 mg po QAM for 4 weeks and built up to 40 mg po QAM in February 2020.Depressive symptoms emerged in Spring 2020, around the time of the COVID-19 pandemic, despite ongoing treatment with fluoxetine. There was a significant increase in aggression, agitation, and compulsive cleaning, which did not respond to the addition of lorazepam 0.5 mg po daily. Owing to concerns that medication was exacerbating his presentation, his prescriber began to wean him off both atomoxetine and fluoxetine.Sam presented to the Emergency Department in the summer of 2020 due to worsening symptoms, including suicidal ideation and aggression, in the context of medication adjustment, social isolation, and academic difficulty with virtual schooling. He completed a 3-week inpatient hospitalization followed by a 2-week virtual partial hospitalization program, during which Sam struggled with attention and engagement. As part of his discharge plan, he was referred to the outpatient psychiatry department to continue outpatient therapy and medication management.During the virtual transfer appointment to outpatient therapy, his parents reported persistent concerns for ongoing attention-deficit/hyperactivity disorder, depression, anxiety, and obsessive-compulsive symptoms, along with a fear of a resurgence of suicidal thinking. Sam reported exhaustion from virtual partial hospitalization program sessions he attended earlier in the day and was eager to leave the appointment. He minimized concerns, denied suicidal ideation or intent, and reported a strong disinterest in doing "another virtual therapy." In-person sessions would be ideal for Sam, given his history of attention difficulties, clinical complexity, and acuity and his self-identified dislike for virtual settings. However, services needed to be done virtually due to the quarantine shutdown. How would you proceed with treating Sam?

The Association of Health Literacy With the Quality of Discharge Planning and Readiness for Hospital Discharge in Jordanian Acute Myocardial Infarction Patients.

To examine the relationship between health literacy with the quality of discharge planning and readiness for hospital discharge in acute myocardial infarction patients in Jordan. Acute myocardial infarction is a major heart disease caused by plaque formation in coronary arteries. Complications after acute myocardial infarction include readmission and physical complications such as chest pain, and limited health literacy increases the risk of complications. Improving the health literacy of patients can improve postdischarge outcomes and decrease complications. This study was conducted using a cross-sectional design. Data were collected from 123 patients who were recruited from three hospitals in Jordan. A demographics questionnaire and three valid and reliable instruments (Health Literacy Questionnaire, Readiness for Hospital Discharge Scale and Quality of Discharge Teaching Scale) were used to collect the data. The authors adhered to the STROBE checklist during the preparation of this study. The results demonstrated that the Readiness for Hospital Discharge had weak to moderate positive correlations with health literacy scales (r = 0.24-0.36, p < 0.05). The content subscale of the Quality of Discharge Teaching Scale showed weak positive correlations with navigating the healthcare system, finding good health information and understanding health information scales of the Health Literacy Questionnaire. The results reported here indicate that health literacy positively correlates with readiness for hospital discharge and quality of discharge teaching. Improving the health literacy of acute myocardial infarction patients can enhance their discharge planning outcomes. The findings of this study are beneficial for healthcare providers in designing targeted interventions that correspond to health literacy among acute myocardial infarction patients. No patient or public contribution.

The role of routine and structured social needs data collection in improving care in US hospitals.

To understand how health-related social needs (HRSN) data are collected at US hospitals and implications for use. Using 2023 nationally representative survey data on US hospitals (N = 2775), we described hospitals' routine and structured collection and use of HRSN data and examined the relationship between methods of data collection and specific uses. Multivariate logistic regression was used to identify characteristics associated with data collection and use and understand how methods of data collection relate to use. In 2023, 88% of hospitals collected HRSN data (64% routinely, 72% structured). While hospitals commonly used data for internal purposes (eg, discharge planning, 79%), those that collected data routinely and in a structured format (58%) used data for purposes involving coordination or exchange with other organizations (eg, making referrals, 74%) at higher rates than hospitals that collected data but not routinely or in a non-structured format (eg, 93% vs 67% for referrals, P< .05). In multivariate regression, routine and structured data collection was positively associated with all uses of data examined. Hospital location, ownership, system-affiliation, value-based care participation, and critical access designation were associated with HRSN data collection, but only system-affiliation was consistently (positively) associated with use. While most hospitals screen for social needs, fewer collect data routinely and in a structured format that would facilitate downstream use. Routine and structured data collection was associated with greater use, particularly for secondary purposes. Routine and structured screening may result in more actionable data that facilitates use for various purposes that support patient care and improve community and population health, indicating the importance of continuing efforts to increase routine screening and standardize HRSN data collection.

The Predictive Effect of the Level of Psychological Resilience on the Level of Readiness for Discharge in Patients Undergoing Orthopaedic Surgery.

The aim of this study is to establish the correlation between the degree of psychological resilience and readiness for discharge in patients undergoing orthopaedic surgery. This study is of a descriptive correlational type. This study comprised a cohort of 190 patients who were admitted to the orthopaedics and traumatology department and had surgical procedures performed between November 2023 and April 2024. The study data were gathered via completion of the Introductory Information Form, the Psychological Resilience Scale and the Hospital Discharge Readiness Scale. IBM SPSS 25 package program was used to analyse the research data. In this study, 34.2% of the participants stated that they did not feel ready for discharge. Predictors of Readiness for Hospital Discharge were identified as being male (β = 0.118, p = 0.003), living alone (β = 0.222, p < 0.001), having undergone prosthesis, fracture or amputation surgery (β = 0.161, p < 0.001), not having received discharge training (β = 0.122, p = 0.001), not feeling ready for discharge (β = 0.442, p < 0.001) and resilience (β = 0.246, p < 0.001). These variables were found to explain 88.7% of Readiness for Hospital Discharge (adjusted R2 = 0.773). The findings of this study emphasise that including patients in their healthcare and creating comprehensive discharge plans tailored to their specific care requirements have a beneficial impact on their readiness for discharge. Additionally, the study demonstrates that enhancing psychological resilience plays a mediating role in facilitating discharge readiness. Patients who feel ready for discharge are less likely to be hospitalised and their recovery may be faster. Including the patient in the discharge plan, taking individual needs into consideration and disseminating programmes to increase resilience should be an integral part of holistic care. The STROBE checklist was applied in the reporting of the finding.

Type 1 Diabetes in care homes: A practical guide on management.

The primary purpose of the original NAPCHD project was to develop a national Strategic Document of Diabetes Care for Care Homes which has now been completed and well received as a worthwhile, sustainable, and effective guidance for delivering quality diabetes care in the UK. A Working Group of NAPCHD was established to produce a Position Statement on type 1 diabetes in care homes since this area was recommended as a topic to further develop. There are currently limited data on the prevalence and clinical outcomes associated with type 1 diabetes in care homes and management policies have been non-existent in the UK. Communication among all key stakeholders involved in direct care of residents with type 1 diabetes is generally fragmented and lacks coordination. This is compounded by a slowly growing utilisation of diabetes technology and the absence of a standard/agreed community-based model of interdisciplinary collaboration. The Rationale and Objectives were defined prior to commencing the work and a work plan with individual tasks was initially set out. After multiple correspondences and Team calls over a period of 9 months, the Group successfully generated a first draft in October 2023. This draft was then finalised the following month and circulated among stakeholders for feedback. Nine chapters have been provided including minimum standards of diabetes care, insulin regimens, avoiding hospitalisation and discharge planning. A scheme for a community-based model of care for type 1 diabetes has been included. Eight key messages were developed. In addition, an Appendix has been created which includes key assessments such as nutritional assessment, detection of frailty, sick day rules and foot risk stratification (available online).

Who gets the bed: Factors influencing the intensive care exit block - A qualitative study

BackgroundPatient flow problems, including discharge delay and after-hours discharge, have been a consistently major issue, especially for intensive care units (ICUs). Evidence suggests that discharge delay and after-hours discharge are associated with increased ICU and hospital length of stay, leading to worsened patient outcomes and increased healthcare costs. They can also increase ICU readmission and post-ICU mortality. The factors influencing discharge processes are not well elucidated. ObjectiveThis study aimed to explore the barriers and facilitators to the ICU patient discharge processes in adult ICUs. MethodsThis qualitative exploratory multisite observational study was conducted in three regional adult ICUs in Queensland, Australia. We used staff interviews, fieldnotes, and document analysis as data collection techniques. Data analysis commenced with a deductive content analysis using the Structure, Process, and Outcomes framework. Following this, an inductive process was taken using the Theoretical Domains Framework. FindingsWe conducted 59 staff interviews and analysed the discharge documents across three sites. Five domains, including context and resources, beliefs about consequences, social/professional role and identity, and behaviour regulation, were strongly related to the factors that influenced the discharge processes. The findings revealed barriers to discharge, including finding the right bed, disconnected and ineffective information systems, ineffective communication and coordination within and across teams and departments, and uncertainty and inconsistency in discharge decision making. Facilitators included clarity on professional roles in ICU discharge, effective communication within the ICU team, and context specific strategies to support the discharge processes. ConclusionsThe findings provide an in-depth understanding of the barriers and facilitators to the ICU discharge processes. Multifaceted strategies should be considered to facilitate and manage ICU discharge safely and efficiently, including the use of clearer discharge criteria and guidelines, digital systems that aid communication and coordination, and early planning of ICU patient discharge.

Analysis of structured discharge planning implementation for discharged inpatients: a multicenter study

Discharge planning is an approach taken by the nurse, patient, and family that includes a needs assessment that will address a detailed care plan after the patient is discharged from the hospital. Discharge planning is essential for patients to prevent re-visiting patients with the same complaints or symptoms that require new treatment and to reduce length of stay for patients. In addition, a structured discharge planning can improve the quality of nursing care. This study aimed to analyze the implementation of structured discharge planning in inpatients. The method employed is a descriptive quantitative carried out in 9 hospitals. The results show that 78.03% of discharge planning has been carried out on inpatients. 54.3% of discharge planning was carried out since the patient's admission, and 45.7% was carried out when the patient was about to be discharged. Discharge planning is carried out ranging from assessment, diagnosis, intervention, implementation and evaluation. Discussion and conclusion state that the discharge planning has been carried out in a structured manner but the implementation has not been optimal and has not been fully performed when the patient is admitted to undergo treatment at the hospital.

Caregivers' Mastery in Handling Gastrostomy at Home after Educational Intervention: Qualitative Descriptive Study.

Effective hospital discharge planning is crucial, particularly in educating caregivers on handling medical devices. This education helps manage the patient's signs and symptoms, prevents post-discharge complications, and reduces early readmissions. This study aimed to understand aspects involved in the acquisition of mastery by home caregivers, in handling care of a patient who just underwent gastrostomy, after educational intervention during hospitalization and telemonitoring upon return home. Qualitative descriptive study. It followed 15 caregivers of people with percutaneous endoscopic gastrostomy. The intervention took place between November 2022 and July 2023 in the neuromusculoskeletal unit of a Brazilian university hospital. The educational intervention had four stages. In stage 1, caregivers felt confused and uncertain about managing PEG. By stage 2, they expressed a desire to be capable of handling care, especially in the event of potential complications, and showed increased awareness and engagement. Stage 3 highlighted the effectiveness of hands-on training with feedback from professionals. In stage 4, during monitoring, several complications were noted, including granuloma formation in the stoma, tube obstruction, and accidental tube loss. However, caregivers demonstrated the ability to handle these situations, indicating the effectiveness of the training and telemonitoring interventions. Nursing professionals should consider various factors when training caregivers in a hospital setting, including providing adequate space, allocating sufficient time for educational interventions, offering both theoretical and practical demonstrations, ensuring effective communication, and taking into account the caregivers' context, as they play a direct role in acquiring a safe and effective skill set.

The Effectiveness of Discharge Planning Implementation in Diabetes Mellitus Patient to Improve Patient’s Discharge Readiness

Diabetes mellitus sufferers experience disturbances in the system of regulating blood sugar levels, insulin is not sufficient to cope so that blood sugar levels increase. This causes patients to require long-term care, so they must be given discharge planning. This research aims to analyze the effectiveness of implementing discharge planning in diabetes mellitus patients to increase patient readiness to go home in the Cempaka Room at Bali Mandara Hospital. The research method used univariate descriptive analysis, and the sample used was in accordance with predetermined inclusion and exclusion criteria and then one respondent was selected. The research results showed that a 61-year-old patient with a diagnosis of diabetes mellitus who met the criteria was given discharge planning and measured using the adult Indonesian version of the patient discharge readiness scale instrument. The pre-test results showed that the patient's readiness level for discharge was 49.52% with a total score of 104 (level II). After implementing discharge planning, the level of patient readiness for discharge increased to 64.28% with a total score of 135 (level III). The implementation of patient discharge planning has proven to be effective in increasing patient discharge readiness, as evidenced by an increase in patient discharge readiness from level II to level III. Therefore, in providing nursing care, it is necessary to pay attention to the patient's detailed needs and fulfill them by implementing discharge planning so that patients have a good level of readiness to go home to reduce recurrence, complications, and patient readmissions.

Patient control preferences prior to discharge after cardiac surgery

Abstract Background The impact of patient preferences and participation in the acute recovery period prior to discharge after cardiac surgery is not well understood. Although there is a plethora of literature describing pre and post discharge interventions to support patients’ recovery there is minimal evidence demonstrating the effectiveness of specific interventions that optimise recovery or patient preferences for participation in decision making related to this period of transition from hospital to home. Purpose The aim of this study was to explore patient preferences for participation in discharge planning. Methods This study took place in a major metropolitan hospital in Victoria, Australia with a population base of over 1 million people that provides over 100,000 episodes of care and approximately 850 cardiothoracic procedures annually. We recruited consecutive adult patients, able to understand and speak English who were being discharged home after cardiac surgery. Prior to discharge, a Registered Nurse conducted a semi-structured interview following patient consent where patients were asked to complete the 5 item Control Preferences Scale (CPS) in relation to 3 discharge planning questions. With each question patients were asked to rate their preferred and actual role in the decision-making process. The CPS has 5 cards each portraying a role in treatment decision making; active (1-2), collaborative (3) or passive (4-5) participation to determine what level of control patients’ desire in relation to their care. Results From 196 patients undergoing cardiac surgery 63 (32.1%) were eligible and agreed to participate. When asked about making plans for discharge 9 (14.3%) patients’ preference was to have an active role in this process, 25 (39.7%) preferred a collaborative approach and 29 (46.1%) a passive approach. Patients perceived their actual role was active (n = 10, 15.9%), collaborative (n = 17, 27.0%) or passive (n = 36, 57.1%). When asked about deciding when to go home 9 (14.3%) patients’ preference was to have an active role in this process, 18 (28.6%) preferred a collaborative approach and 36 (57.1%) preferred a passive approach. Patients perceived their actual role was active (n = 8, 12.7%), collaborative (n = 13, 20.6%) or passive (n = 42, 66.6%). When asked about their preferred role in deciding where they go when discharged 21 (33.4%) patients’ preference was to have an active role in this process, 19 (30.2%) preferred a collaborative approach and 23 (36.5%) a passive approach. Patients perceived their actual role was passive (n = 24, 38.1%), collaborative (n = 16, 25.4%) or passive (n = 23, 36.5%). Conclusion Patient preferences for control were congruous with their perceived experience of involvement in decision making which indicates patients’ preference for control is taken into account by clinicians managing the discharge planning process in this setting.