Discharge Services Research Articles

Patient, carer and health worker perspectives of stroke care in New Zealand: a mixed methods survey

Purpose It is important to understand how consumers (person with stroke/family member/carer) and health workers perceive stroke care services. Materials and methods Consumers and health workers from across New Zealand were surveyed on perceptions of stroke care, access barriers, and views on service centralisation. Quantitative data were summarised using descriptive statistics whilst thematic analysis was used for free-text answers. Results Of 149 consumers and 79 health workers invited to complete a survey, 53 consumers (36.5%) and 41 health workers (51.8%) responded. Overall, 40/46 (87%) consumers rated stroke care as ‘good/excellent’ compared to 24/41 (58.6%) health workers. Approximately 72% of consumers preferred to transfer to a specialised hospital. We identified three major themes related to perceptions of stroke care: 1) ‘variability in care by stage of treatment’; 2) ‘impact of communication by health workers on care experience’; and 3) ‘inadequate post-acute services for younger patients’. Four access barrier themes were identified: 1) ‘geographic inequities’; 2) ‘knowing what is available’; 3) ‘knowledge about stroke and available services’; and 4) ‘healthcare system factors’. Conclusions Perceptions of stroke care differed between consumers and health workers, highlighting the importance of involving both in service co-design. Improving communication, post-hospital follow-up, and geographic equity are key areas for improvement. Implications for rehabilitation Provision of detailed information on stroke recovery and available services in the community is recommended. Improvements in the delivery of post-hospital stroke care are required to optimise stroke care, with options including routine phone follow up appointments and wider development of early supported discharge services. Stroke rehabilitation services should continue to be delivered ‘close to home’ to allow community integration. Telehealth is a likely enabler to allow specialist urban clinicians to support non-urban clinicians, as well as increasing the availability and access of community rehabilitation.

Protocol for the development of a clinical practice guideline for discharge planning of stroke patients.

BackgroundA standardized discharge plan is important to continuous medical care and discharge management of stroke patients. Currently, there is a lack of high-quality, evidence-based discharge planning guidelines for stroke patients. Most existing discharge planning guidelines have been developed for other diseases and stroke-related guidelines focus more on prevention, treatment, and rehabilitation and less on discharge planning. Therefore, they do not provide a systematic and comprehensive answer to the key issues of discharge planning for stroke patients. To improve the level of recovery and quality of life of stroke patients, to better guide clinical caregivers in developing and implementing discharge plans, the Evidence-based Nursing Center of West China Hospital, Sichuan University and the World Health Organization (WHO) Collaborating Centre for Guideline Implementation and Knowledge Translation have jointly initiated the development of the clinical practice guideline for discharge planning of patients with stroke.MethodsThe guideline development process is designed to follow the WHO handbook for guideline development and Guidelines 2.0. Evidence grading and guideline recommendations are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The key steps in developing the guideline include: (I) establishing the guideline working groups; (II) selecting the priority clinical questions; (III) evidence retrieval and evaluation; (IV) grading the quality of evidence; (V) forming recommendations; and (VI) external review.DiscussionThis guideline will follow the clinical characteristics and management priorities of stroke and will be developed by a multidisciplinary guideline development team, in strict accordance with the core principles and methods of guideline development. This guideline will provide an evidence-based reference for standardized discharge screening, assessment, discharge procedures, and outpatient follow up, so as to improve the quality of discharge services and standardize the discharge management of stroke patients, and ultimately improve their post-discharge rehabilitation and quality of life.Trial RegistrationThe guideline was registered at the Practice guidelines REgistration for transPAREncy. The registration No. is IPGRP-2022CN331.

Retrospective Evaluation of Discharge Planning Linked to a Long-Term Care 2.0 Project in a Medical Center.

Background: Although there are several studies on discharge planning and long-term care systems in individual programs, research on the connection between discharge planning and the usage of long-term care is scanty. This study aims to evaluate the nature of the association between discharge planning (DP) and long-term care (LTC) and whether the utilization of LTC services improved after being discharged. Methods: This was a single-center retrospective medical record review study. Secondary data analysis was conducted of DP–LTC participation data between 2018 and 2019. The objectives were to clarify the distinct characteristics of each part of the service to explore the utility rate by overall users and users with willingness and to determine the factors influencing their usage. Medical claims were used to identify inpatients receiving discharge services, and data were matched with LTC system engagement data (n = 2155). Backward stepwise regression was used to explore the attributes associated with each type of service use. Results: A total of 94% (2042/2155) of inpatients expressed a perceived need for LTC services, of which 14% (285/2042) were users of LTC services after discharge. When assessed by case-mix system (CMS) and willingness to use services during hospitalization, inpatients had higher rates of service utilization after discharge. Using LTC services was most likely to be associated with obesity, disability, high CMS level, higher education, and women. Conclusion: The study confirms that the utilization of LTC services has improved under the integrated DP–LTC system. The gap between willing and actual users is worth considering. In the assessment stage, special attention should be paid to the service needs of persons with BMI ≥ 27 and disabilities. Future research with a larger sample could comprehensively evaluate the impact of integrated DP services on the use of LTC 2.0 service resources.

Caregiver Inclusion in IDEAL Discharge Teaching: Implications for Transitions From Hospital to Home.

Despite recognition that unpaid (e.g., family, friends) caregivers (caregivers) play an important role in successful transitions home after hospitalization, limited information is available about whether and how caregiver experiences of discharge align with current strategies for providing high-quality discharge processes, and how these experiences at discharge impact successful transitions home. The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted postdischarge patient outcomes. We conducted in-depth, case interviews with four English-speaking caregivers (61-75 years of age). Content analysis was framed by the nature of caregiver involvement proposed by the Agency for Healthcare Research and Quality's (AHRQ's) IDEAL (Include, Discuss, Educate, Assess, Listen) discharge planning strategy. Caregivers reported receiving clear discharge instructions, or basic education, and yet felt only passively included in discharge teaching. Once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to postdischarge knowledge gaps. The experiences of these caregivers demonstrate how their limited, passive involvement in discharge education may result in suboptimal patient outcomes after hospitalization. Our findings suggest that structured programs aimed at increasing caregiver involvement in discharge, particularly related to assessment of caregiver problem solving, planning, and postdischarge support, are important in efforts seeking to improve care transitions and postdischarge outcomes. This study assesses caregivers' experience with discharge planning and problems they encounter post-discharge, providing case managers with important information regarding the effectiveness of discharge processes. This study of caregiver experiences suggests that the IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.

Impact of a Transition of Care Pharmacist in a Community Hospital Discharge Model.

Pharmacists can provide a variety of discharge services that aid in transitions of care. The purpose of this study is to evaluate the impact of a pilot program implementing a unit-based clinical pharmacist at a community teaching hospital. This prospective study evaluated pharmacist-led discharge services on an adult medicine unit over a 5-week period. The control cohort received usual care, and the intervention cohort received additional pharmacy services (e.g., counseling, medication reconciliation, ensuring medication access, and overcoming discharge barriers). The primary outcome was 30-day all-cause hospital readmissions. Secondary outcomes included emergency department (ED) utilization, Hospital Consumer Assessment of Healthcare Providers and Systems scores, and patient satisfaction survey scores. Overall, 197 patients were included in the control group and 210 in the intervention group. Characteristics including previous hospital utilization, comorbidity count, and medication count at discharge were similar between groups. A reduction in 30-day all-cause hospital readmissions was observed in the cohort receiving pharmacist intervention, 13.3% versus 20.8% (p = 0.044). This study also demonstrated a significant decrease in ED utilization rates and improved patient satisfaction. This study adds to the growing body of literature supporting transition of care pharmacists in the hospital discharge model to improve patient care.

Effectiveness of nurse-led discharge service on adult surgical inpatients: A meta-analysis of randomized controlled trials.

AimTo determine the effectiveness of nurse‐led discharge service for adult surgical inpatients.DesignThe report of this review was conducted by the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) statement checklist.MethodsThe PubMed, Web of Science, ScienceDirect, Cochrane Library (CENTRAL), MEDLINE and Embase as well as four Chinese databases including CNKI, Wanfang database, VIP database and CBM were searched for randomized controlled trials. Two reviewers independently extracted data and assessed risk of bias. And meta‐analyses were conducted for the eligible studies by Review manager 5.4.1.ResultsA total of 1,649 participants were enrolled in 12 randomized controlled trials. The result of readmission rate and emergency visit of intervention group were lower than those of the control group; activities of daily living and quality of life in the intervention group were higher than that of the control group. There was no statistical difference in the length of stay between the two groups.

Readmission risk identification: Implementation of a patient-centered interview.

6564 Background: Unplanned 30-day readmissions in the cancer population are common. There are few large studies describing cancer patients’ readmission perspective. To better define predisposing factors associated with readmission, our Nurse Case Manager team implemented a patient-focused survey. Methods: Cancer patients readmitted to The James Cancer Hospital from May 2020-December 2021 were included. Readmission events were defined as an inpatient hospital readmission within 30 days of the patient’s prior hospitalization. Team members conducted a 16-question survey immediately following readmission to evaluate the patients’ perspective on factors that may have contributed to their readmission; results were recorded. Results: A total of 3,333 readmissions were unplanned, 109 planned, 22 listed as other; 3,464 patients completed interviews (Table). During their index admission, most patients reported receiving (90%) and understanding (89%) discharge education/instructions. Upon index discharge, most patients (62%) were discharged on a new medication; the majority reported filling their prescription (95%) and taking it as instructed (98%). Nearly all patients had a post-index hospitalization follow up appointment scheduled, but only 58% reported attending. The primary reason reported for not attending was readmission prior to the appointment. Just over 50% of patients received a post-index hospital stay phone call. Some patients (6% yes; 58% unanswered) felt services at discharge would have been helpful. Most patients (51%) contacted their provider regarding worrisome symptoms experienced prior to being readmitted. Pain (18%), fever (11%), and shortness of breath (10%) were the most commonly reported symptoms that prompted returning to the hospital. Conclusions: To our knowledge, this is the largest study to date of cancer patients’ own perspective of their 30-day readmission. More immediate post-hospitalization follow up and increased deployment of tailored discharge services represent areas of opportunity identified to decrease readmission rates. Symptom-specific interventions may also be impactful. Due to the negative downstream effects readmissions have on the healthcare system, it is critical to develop risk mitigation strategies incorporating patient-reported experience. [Table: see text]

Day-ahead and real-time congestion scheduling method for distribution network with multiple access to electric vehicle charging piles

Abstract The day-ahead and real-time congestion scheduling method for distribution network with multiple access to electric vehicle charging piles is studied to effectively solve the day-ahead and real-time congestion scheduling problem of distribution network. The charge adjustment strategy of charge and discharge service fee is established to realize the double response regulation between the distribution system’s scheduling organization and the charging pile operator; considering the adjustment strategy of charging service fee, a day-ahead congestion scheduling model is established with the goal of minimizing the charging cost of electric vehicles; based on the day-ahead congestion scheduling, a real-time congestion scheduling model is established to minimize the regional power fluctuation; the day-ahead and real-time congestion scheduling model is solved by differential evolution algorithm, and the optimal scheduling scheme is obtained. Experiments show that this method can reduce the line load rate of distribution network, avoid re-congestion, reduce the congestion scheduling cost and improve the security and economy of power grid operation.

Effectiveness of interventions to support the transition home after acute stroke: a protocol for a systematic review.

Background Despite advances in the quality of acute stroke management, there are gaps in knowledge about effective support interventions to better manage the transition of care to home for patients with this complex condition. The goal of this systematic review is to explore the literature around support interventions available for patients as they navigate from acute hospital, rehabilitation or early supported discharge (ESD) services to independent living at home; and toestablish if, in comparison with usual care or other comparative active interventions, support services offered to patients as they transition from acute hospital, inpatient rehabilitation/ESD to home, can achieve better patient and / or process outcomes. Protocol In June 2021, we will carry out, on electronic peer-reviewed databases, a comprehensive literature search based on a pre-defined search strategy, developed and conducted in collaboration with an Information Specialist. In an effort to identify all published trials we will perform citation tracking of included studies, check reference lists of relevant articles, review grey literature, and extend our search to google scholar. We will include randomised controlled trials (including cluster and quasi-randomisation) recruiting stroke patients transitioning to home, to receive either usual care or any support intervention designed to improve outcomes after stroke. The primary clinical outcome will be functional status. Two review authors will scrutinise trials, categorise them on their eligibility, and extract data. We will analyse the results for all trials and perform meta-analyses where possible. We will assess risk of bias for the included trials and use GRADE to assess the quality of the body of evidence. Patient and public involvement (PPI)engaged in the development of the research questions, and will participate in co-design of a strategy for dissemination of findings. Conclusions: The findings from this review will be used to identify knowledge gaps to direct future research.

683 UNDERSTANDING HOW DISCHARGE SERVICES FOR OLDER PATIENTS CAN BRIDGE THE GAP BETWEEN HOSPITAL, COMMUNITY AND SOCIAL CARE

Abstract Introduction UK policy recommends that discharge support is provided by hospital, community and social care staff. However, there is a lack of understanding regarding how these multiagency hospital discharge services work in practice, how they can be sustained and what service stakeholder experiences of them are. This research aimed to understand how integrated discharge services work and the views and experiences of stakeholders. Method A qualitative case study of a supported integrated hospital discharge service (SIHDS) for older people was undertaken, which involved interviews with service staff (hospital, community and social care), patients and carers. Staff, patients and carers were interviewed on their experiences of SIHDS. Staff also took part in a process mapping exercise to understand how the service works. Interviews were analysed using thematic analysis. Ethical approval was obtained for this research. Results A variety of staff (n = 14) and patients aged over 60 years (n = 11) and their informal carers/family members (n = 4) were interviewed. Three main staff themes emerged from the findings: 1. Preparedness for discharge and impact of discharge service; 2. Integration and impact on patient pathway and 3. Organisational aspects. The three main patient/carer themes were: 1. Support for patients; 2. Patient Outcomes and 3. Information exchange. The findings demonstrated that: SIHDS was seen as important to allow patients to be discharged home in a timely and safe manner; that communication is important at all levels of a SIHDS and SIHDS need to continuously evolve to provide patient centred care. Conclusion The findings from this qualitative case study allow the complexities involved in SIHDS to be understood from the experiences and perspectives of multiagency staff, patients and carers. It shows SIHDS are complex, but useful to overcome gaps between services. However, to effectively sustain a patient centred service it is important to regularly review and develop SIHDS.

682 IMPACT OF DISCHARGE INTERVENTIONS FOR OLDER PATIENTS LEAVING HOSPITAL: A SYSTEMATIC REVIEW OF REVIEWS

Abstract Introduction The UK has an aging population and there is an increasing need for additional care and support services for elderly patients discharged from hospital. Despite a large evidence base on different discharge services there is inconsistent findings on their effectiveness. This systematic review of reviews aimed to evaluate the impact of a variety of discharge interventions on older people leaving hospital. Method Ten databases were searched (including Medline and The Cochrane Library) using multiple key search terms related to ‘systematic reviews’, ‘older people’ and ‘discharge’. Only systematic reviews of interventions for people aged over 60 years that provided additional support or adapted their discharge processes were included. Outcomes of interest included mortality, readmissions, length of hospital stay, patient health status and costs. Abstract, title and full-text screening was conducted independently by two reviewers. Interventions were categorised by intervention type and a narrative synthesis was conducted on data extracted. Results Of the 8,748 title and abstracts reviewed, 859 full texts were assessed for eligibility, of these 91 were taken forward to quality assessment and 66 moderate or high-quality reviews were included in the final synthesis. Interventions were categorised into 10 types and had varying impact on outcomes. A statistically significant positive impact on the outcomes of interest was found for: Interventions providing ‘rehabilitation, therapy or care at home (or in the community) around the time of discharge’ reducing length of stay; ‘primary care interventions’, ‘Discharge planning/coordination or case management’ and ‘patient education’. Conclusion This systematic review of reviews shows that different types and configurations of discharge interventions can benefit older patients in multiple ways when compared to usual care and highlights which intervention types make no difference or have negative impacts. These findings will help to inform the development of new discharge interventions and the direction of future research.

Effectiveness of interventions to support the transition home after acute stroke: a protocol for a systematic review

Background Despite advances in the quality of acute stroke management, there are gaps in knowledge about effective support interventions to better manage the transition of care to home for patients with this complex condition. The goal of this systematic review is to explore the literature around support interventions available for patients as they navigate from acute hospital, rehabilitation or early supported discharge (ESD) services to independent living at home; and to establish if, in comparison with usual care or other comparative active interventions, support services offered to patients as they transition from acute hospital, inpatient rehabilitation/ESD to home, can achieve better patient and / or process outcomes. Protocol In June 2021, we will carry out, on electronic peer-reviewed databases, a comprehensive literature search based on a pre-defined search strategy, developed and conducted in collaboration with an Information Specialist. In an effort to identify all published trials we will perform citation tracking of included studies, check reference lists of relevant articles, review grey literature, and extend our search to google scholar. We will include randomised controlled trials (including cluster and quasi-randomisation) recruiting stroke patients transitioning to home, to receive either usual care or any support intervention designed to improve outcomes after stroke. The primary clinical outcome will be functional status. Two review authors will scrutinise trials, categorise them on their eligibility, and extract data. We will analyse the results for all trials and perform meta-analyses where possible. We will assess risk of bias for the included trials and use GRADE to assess the quality of the body of evidence. Patient and public involvement (PPI) engaged in the development of the research questions, and will participate in co-design of a strategy for dissemination of findings. Conclusions: The findings from this review will be used to identify knowledge gaps to direct future research.

INFLAMMATORY BOWEL DISEASE IN APPALACHIA: AN INVESTIGATION INTO DISPARATE OUTCOMES WITHIN THE STATE OF KENTUCKY

Abstract INTRODUCTION Inflammatory Bowel Disease (IBD) affects an estimated 3.1 million US adults, with an increasing prevalence in recent years1. Of these, 1.1 million live in the CDC classified “Southern” region, which includes the state of Kentucky. The eastern portion of the state is part of the Appalachian region, a low-resourced area with a dense, vulnerable population. The majority of Kentucky’s Appalachian counties are classified as distressed (ranked bottom 10% in the US based on economic development), and suffer a higher prevalence of chronic disease2. To our knowledge, there is no published data quantifying the healthcare burden of IBD or evaluating disease outcomes in this vulnerable community. METHODS We utilized the hospital inpatient discharge and outpatient services databases available through the healthcare cost and utilization project (HCUP) to assess outcomes among patients with a diagnosis of either Crohn’s disease (CD) or Ulcerative Colitis (UC) in the state of Kentucky. Outcomes of interest were aggregated at the county level and included number of hospital admissions, number of total outpatient visits and visits to an emergency department, inpatient and outpatient surgeries. Data was reported as number of incident visits per 100,000 population/year, collected between the years 2009-2019. RESULTS We found that CD patients residing in Appalachian counties were more likely to be admitted to the hospital (42.72 vs. 29.69, p-value= 0.0001), require inpatient surgery (6.91 vs 5.35, p-value= 0.006), and be admitted for abdominal pain as a complication of their disease (3.82 vs 2.28, p-value = 0.0031) than non-Appalachians. Appalachian CD patients also had a higher number of ER visits (84.06 vs. 52.64, p-value = 0.0102), outpatient surgery visits (161.24 vs 112.35, p-value = 0.0024), and clinic visits for abdominal pain (39.8 vs 24.34, p-value=0.0002) than non-Appalachians. UC patients in Appalachian counties were more likely to require inpatient surgery (1.36 vs 0.74, p-value 0.0007) than non-Appalachians. There was no significant difference in rates of fistula, perforation, or malabsorption in either CD or UC based on Appalachian county data. CONCLUSION These data support the notion of disparate outcomes in IBD based on Appalachian county residence in the state of Kentucky. This was most striking when evaluating Crohn’s disease in Appalachians, as evidenced by hospital admissions, surgeries, and ER visits. Appalachian inpatients with UC had a significantly higher rate of surgical resection. These findings highlight a need for aggressive investigation into root causes of these disparate outcomes, with particular attention to identifying and subsequently alleviating barriers to IBD care. Whether these data infer treatment of Appalachian IBD patients should be managed more aggressively earlier in the disease course awaits further investigation.

Can telerehabilitation services combined with caregiver-mediated exercises improve early supported discharge services poststroke? A study protocol for a multicentre, observer-blinded, randomized controlled trial

BackgroundRecovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home. Caregiver-mediated exercises could be a resource-efficient strategy to augment exercise therapy and improve mobility in the first months poststroke. A combination of telerehabilitation and face-to-face support, blended care, may empower patient-caregiver dyads and smoothen the transition from professional support to self-management. The Armed4Stroke study aims to investigate the effects of a caregiver-mediated exercise program using a blended care approach in addition to usual care, on recovery of mobility in the first 6 months poststroke.MethodsA multicentre, observer-blinded randomized clinical trial in which 74 patient-caregiver dyads will be enrolled in the first 3 months poststroke. Dyads are randomly allocated to a caregiver-mediated exercises intervention or to a control group. The primary endpoint is the self-reported mobility domain of the Stroke Impact Scale. Secondary endpoints include care transition preparedness and psychological functioning of dyads, length of inpatient stay, gait-related measures and extended ADL of patients, and caregiver burden. Outcomes are assessed at enrolment, end of treatment and 6 months follow-up.ResultsDuring 8 weeks, caregivers are trained to become an exercise coach using a blended care approach. Dyads will receive a tailor-made, progressive training program containing task-specific exercises focusing on gait, balance, physical activity and outdoor activities. Dyads are asked to perform the training program a minimum of 5 times a week for 30 min per session, supported by a web-based telerehabilitation system with instruction videos and a messaging environment to communicate with their physiotherapist.ConclusionsWe hypothesize that the Armed4Stroke program will increase self-reported mobility and independence in ADL, facilitating an early discharge poststroke. In addition, we hypothesize that active involvement of caregivers and providing support using blended care, will improve the care transition when professional support tapers off. Therefore, the Armed4Stroke program may complement early supported discharge services.Trial registrationNetherlands Trial Register, NL7422. Registered 11 December 2018.

Telephone Consultation in Otorhinolaryngology During the Coronavirus Disease 2019 Pandemic: a Cross-sectional Analysis of Effectiveness and Satisfaction for Patients and Clinicians.

The COVID-19 pandemic has necessitated measures to minimise face-to-face interaction. We assessed the efficacy of teleconsultation and patient satisfaction in adult otorhinolaryngology clinic. A prospective review of telephone consultations over 6 months in a single district general hospital was conducted. Data was collected on the characteristics and outcomes of teleconsultations by clinicians, and a questionnaire was sent to patients. Of 304 telephone consultations, 115 were new and 189 were follow-up. Five percent of patients were listed for surgery. The discharge rate was 31%, largely comprising of patients with otorhinolaryngological symptoms. High clinician and patient satisfaction were reported by 90% and 96%, respectively. Telephone consultation was a good one-stop treat and discharge service for a number of otorhinolaryngological complaints such as hearing loss, tinnitus and recurrent tonsillitis. Patient and clinician satisfaction was high. Careful triaging of referrals for telephone consultation can potentially reduce the number of face-to-face clinic appointments.

Joint Mediation of Psychosis and Mental Stress on Alcohol Consumption and Graduates’ Job Performance: A PLS Structural Equation Modeling

AbstractPrevious research has interlinked alcohol consumption (AC), mental stress (MS), psychotic experiences (PE), and academic performance (AP) of students and psychological behavior of the general population. The current study seems to be the first to consider the joint and partial mediation effects of MS and PE in linking AC to graduates’ job performance in specific areas such as teamwork (TW), communication competence (CC), customer service (CS), and job functions (JF). A virtual cross-section of 3,862 graduates with self-reported cases of having taken alcohol in the past participated in the study. These participants responded to an electronic questionnaire that was mailed to them. The instrument used for data collection had acceptable psychometric properties. The study used the partial least squares structural equation modeling (PLS-SEM) to achieve its objectives. The inner and outer models were all evaluated for quality and goodness of fit. Results showed a significant negative effect of AC and MS on graduates’ job performance in terms of TW, CC, CS, and JF, respectively. AC had a significant positive effect on MS and PE. MS had a significant positive effect on PE. A significant joint mediation effect of MS and PE was found in linking AC to graduates’ TW, CC, and CS, excluding JF. MS partially mediated AC’s paths to all the graduates’ job performance indicators. PE was only a significant partial mediator of the connection between AC to JF, but not TW, CC, and CS. This study’s result can help improve graduates’ work effectiveness and has revealed some negative predictors. Therefore, it is recommended that graduates avoid alcohol or only consume mild quantities of it to enable them to discharge services effectively at the workplace.

Quarter of referrals under national hospital discharge service from just one area

Community pharmacies across England are experiencing a wide variation in the number of patients referred to them by NHS trusts through the ‘discharge medicines service‘ (DMS), NHS data have revealed. The figures, published monthly by NHS Business Services Authority (NHSBSA) and analysed by The Pharmaceutical Journal, show that community pharmacies have claimed for 63,109 referrals […]

Planning for Safe Hospital Discharge by Identifying Patients Likely to Fall After Discharge.

Acute care physical therapists recommend discharge locations and services in part to help prevent falls during post-discharge recovery. Therapists may use standardized tests to inform their recommendation decisions, but evidence linking test scores with fall risk after discharge is lacking. The primary purpose of this study was to explore the associations between Tinetti Performance-Oriented Mobility Assessment (POMA) and Activity Measure for Post-Acute Care Inpatient Mobility Short Form (AM-PAC IMSF) scores and falls in the first 30days after hospital discharge. Anticipating that agreement between therapist recommendations and discharge locations and services (discharge agreement), age, and sex could impact those associations, these factors were included in this investigation. In this observational cohort study, 258 hospitalized patients consented to medical record data extraction and answered a phone survey 30days after discharge to report whether they had experienced a fall since leaving the hospital. POMA and AM-PAC IMSF tests were administered for every patient. Participants' age, sex, diagnosis, last POMA score, last AM-PAC IMSF score, physical therapist discharge recommendations, actual discharge location and services, discharge date, and phone number were collected from their medical records. When analyzed alone, higher POMA scores were associated with lower odds of falling, but the association was not significant after adjustment for other factors. Neither AM-PAC IMSF scores, age, nor sex were associated with falls. Discharge agreement, however, was associated with 59% lower odds of falling after adjustment for other factors. Participants, who were discharged to the location with the services recommended by their physical therapist, were less likely to fall. Tinetti POMA and AM-PAC IMSF scores did not discriminate well participants who would fall. Findings in this study inform those involved in discharge planning on the value of implementing physical therapist recommendations in reducing fall risk after hospital discharge. If physical therapist discharge recommendations are implemented, patients are less likely to fall during the month after hospital discharge. Balance and mobility test scores may provide therapists valuable information, but they are limited in their ability to identify who will fall after discharge.

Developing a community-based multidisciplinary service exit typology for young adults with serious mental health conditions.

Objective: Increasingly, community mental health providers are implementing multidisciplinary treatment models blending child and adult evidence-based practices to boost young adult engagement. Although promising, limited research examines how and why young adults disengage from these new models. This study examines provider documentation of treatment discharges to create a more developmentally-attuned young adult service exit typology. Method: Service records of 18-25 year-olds (n = 124) who discharged from a young adult-tailored multidisciplinary treatment team over a 5-year period were analyzed. A research team conducted a systematic content analysis of discharge forms and service notes. Planned and unplanned exits emerged as primary categories, each having distinct subcategories with noted prevalent associated experiences. Results: Participants (n = 124) were enrolled between 7 days to 3.80 years (M = 11.41 months) prior to exit. Those with "planned" exits (n = 71) were enrolled longer than those with "unplanned" exits (n = 53), means respectively 13.17 versus 9.06 months. Planned exits included: transitions either to a lower, similar or higher level of care, a return to previous provider, or insurance issues. Moving outside team geographic area contributed to planned and unplanned exits. Unplanned exits were disproportionately found among participants who were Black, had justice involvement histories, and/or experienced housing instability or homelessness. Conclusions and Implications for Practice: Young adult service exits are complex; planned exits are not always positive and unplanned exits are not always negative. Provider and research use of this new service exit typology has particular implications for identifying engagement disparities-and further tailoring models to be more attractive, culturally responsive, and impactful with young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Facilitating hospital discharge through housing support: a mixed-methods evaluation of a housing association support service in two UK hospitals

BackgroundAppropriate transfer of care from the hospital to the home is vital for improved patient outcomes, but evidence on the effect of housing-based interventions developed to facilitate timely hospital discharge is scarce. We aimed to explore the effect of a housing support coordinator on service users' health and housing outcomes, hospital costs, and hospital discharge processes. MethodsWe did a mixed-methods process evaluation of a housing association service aimed at improving hospital discharge in two hospitals in Yorkshire, UK, from Nov 26, 2020, to Dec 31, 2021. Patients for whom suitable housing was anticipated to be a barrier to timely discharge were referred to the housing service by health-care professionals while in hospital. We undertook interviews with service users and hospital and housing staff, administered a questionnaire to all eligible service users, conducted a secondary analysis of routine data (information on demographics, housing issues, support provided, and housing outcomes collected between April 1, 2018, and May 31, 2021), and did an economic evaluation to assess costs. Service users completed questionnaires at the start and after finishing the service. Questionnaires were also sent to all services users already discharged from the service. Interviewees were recruited via telephone and email. We did a thematic analysis using NVivo 10 software to assess interviews and survey data and statistical analysis for routinely collected data and questionnaire data using SPSS-27. We also did a before-and-after study to compare economic costs. We used a following-the-thread technique to integrate the different methods. Informed consent (both written and verbal, depending on the mode of data collection) was obtained from participants. Ethical approval for this project was granted by North of Scotland Research Ethics committee and the Health Research Authority (REC reference: 20/NS/0050). Findings489 people were supported by the service the majority of whom were male (321 [66%]). Five service users, seven hospital staff, and four housing staff completed interviews, and 31 service users completed a questionnaire (14 prospectively and 17 retrospectively). Service users faced different housing barriers: 136 (28%) of 481 experienced homelessness and a further 80 (17%) of 481 faced challenges with their accommodation no longer meeting their physical needs. Service users found the support useful. Hospital staff at all levels felt the service facilitated discharge, reducing pressure on health-care services. Having skilled housing officers embedded within the patient's care team was valued, with both the questionnaire and routine data highlighting that the housing officers provided support ranging from organising repairs, arranging new accommodation, accessing financial help, and referring to additional services. The service was constrained by the unavailability of appropriate housing stock and wider support systems for service users after discharge. As this study is ongoing, available routine data are currently insufficient to allow reliable quantification of economic impact. InterpretationThe evaluation has shown the benefits of housing discharge services and will inform future commissioning decisions on funding services to facilitate discharge. We recommended that other hospitals with housing-related barriers to discharge might want to adopt a similar model. FundingNational Institute for Health Research (NIHR) School for Public Health Research