Effective Discharge Planning Research Articles

Associations Between Successful Home Discharge and Posthospitalization Care Planning: Cross-Sectional Ecological Study.

Effective discharge planning is crucial for successful care transitions, reducing hospital length of stay and readmission rates. Japan offers a financial incentive to enhance the coordination of posthospitalization care planning for patients with complex needs. However, the national impact of this incentive remains unclear. This study aimed to (1) assess the association between the number of claims submitted for discharge planning, as an indicator of the provision of posthospitalization care planning, and key health care outcomes, including discharges to home, 30-day readmissions, length of stay, and medical expenditures at the prefectural level in Japan, and (2) to describe regional differences in the provision of posthospitalization care planning and explore associated factors. This ecological study used prefectural-level data from fiscal year 2020. Claims submitted for discharge planning were used as indicators that posthospitalization care planning was provided. Supply-adjusted standardized claim ratios (SCRs) were calculated using data from the Seventh National Database of Health Insurance Claims, to evaluate and compare the number of claims across 47 prefectures in Japan, accounting for differences in population structure. Key outcomes included discharges to home, 30-day readmissions, length of stay, and medical expenditures. Multivariate negative binomial regression models assessed associations between SCRs and outcomes, adjusting for socioeconomic covariates. In addition, regional differences in the provision of posthospitalization care planning and associated factors were analyzed using the Mann-Whitney U test. Prefectures were divided into 3 groups (low, medium, and high) based on tertiles of each factor, and supply-adjusted SCRs were compared across these groups. The ratio of the minimum to maximum supply-adjusted SCR was 10.63, highlighting significant regional variation. Higher supply-adjusted SCRs, indicating more frequent provision of posthospitalization care planning, were associated with an increase of 9.68 (95% CI 0.98-18.47) discharges to home per 1000 patients for each SD increase in supply-adjusted SCR. Several factors contributed to regional differences in the supply-adjusted SCR for posthospitalization care planning. A higher supply-adjusted SCR was significantly associated with a greater number of nurses per 100 hospital beds (median SCR in low, medium, and high groups: 0.055, 0.101, and 0.103, respectively); greater number of care manager offices per 100 km2 of habitable area (0.088, 0.082, and 0.116); higher proportion of hospitals providing electronic medical information to patients (0.083, 0.095, and 0.11); lower proportion of older adults living alone (0.116; 0.092; 0.071); and higher average per capita income (0.078, 0.102, and 0.102). The provision of posthospitalization care planning is associated with an increased likelihood of discharge to home, underscoring its importance in care transitions. However, significant regional disparities in care coordination exist. Addressing these disparities is crucial for equitable health care outcomes. Further research is needed to clarify causal mechanisms.

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.

Unlocking success: Multidisciplinary rounds for effective discharge planning.

341 Background: Multidisciplinary rounds (MDR) streamline collaboration among healthcare professionals across various disciplines to devise patient progress and post-hospitalization transition plans. In our gynecology oncology inpatient unit, coordinating patient care involves multiple teams aiming for discharge objectives. While nurses oversee the care plan, physicians, advanced practice providers, case managers, and other key stakeholders possess essential insights to effective discharge planning. The aim of our study was to evaluate the impact of structured MDR implementation on discharge accuracy, effectiveness, and hospital throughput. Methods: In April 2022, our gynecologic oncology inpatient team implemented structured MDRs to enhance discharge processes, focusing on patient outcomes and hospital throughput. The initiative aimed to identify discharge barriers early, set goals, and address challenges collaboratively through: 1) Interdisciplinary Assessment: Using standardized tools to evaluate patient status and care needs; 2) Review of Clinical Data: Analyzing medical records via EHR systems; 3) Collaborative Decision-Making: Using decision-support tools to set the Estimated Discharge Date (EDD); 4) Patient Engagement: Involving patients and families in shared decision-making; 5) Documentation and Communication: Ensuring clear EDD documentation and effective communication through team huddles, bedside rounds, and discharge planning meetings. EDD reporting, discharge order timing, and patient discharge time were tracked using our Care Team Transformation Dashboard. Results: The implementation of structured MDR led to significant improvements in discharge processes. We observed enhanced accuracy in EDD, with a 2.9% increase, and a notable rise in the completion of discharge orders before 9 am, showing a 60.5% increase (Table). The percentage of patients leaving the hospital before noon increased by 20.4%, highlighting MDRs effectiveness in facilitating timely discharge, enhancing intradisciplinary collaboration, and streamlining discharge efficiency. Conclusions: MDRs play a pivotal role in improving teamwork, quality of care, and patient outcomes. Setting EDDs through structured MDR processes enhances proactive discharge planning, thereby reducing delays and optimizing patient flow, ultimately contributing to the delivery of high-quality, patient-centered healthcare. Measure Preintervention: 1/2023-1/2024 Postintervention02-05/2024 Percentage Increase EDD accuracy 1 day prior 46.9 48.3 2.9% Discharge orders before 9am 33.4 53.6 60.5% Discharges prior to noon 19.1 23.0 20.4%

Exploring Predictors of Long-Term Care Facility Admissions in Stroke Survivors: Insights from a Taiwanese Hospital-Based Study.

Acute stroke significantly increases the risk of long-term care facility (LTCF) admission, due to sudden functional impairments. This study aims to identify risk factors associated with LTCF admission among stroke patients, specifically targeting those who transitioned from independence to disability after stroke. We retrospectively enrolled 2027 stroke patients admitted between 2017 and 2022 from the Chi Mei Medical Center's stroke registry in Southern Taiwan, focusing on those with pre-stroke modified Rankin Scale (mRS) scores ≤ 2 and post-stroke mRS scores ≥ 3. Patients were categorized into LTCF and non-LTCF groups. Stroke severity, comorbidities, and discharge outcomes were evaluated, using logistic regression analyses to identify LTCF admission risk factors. Of the 2027 patients, 343 (16.9%) were admitted to LTCFs post-discharge. The LTCF group exhibited higher discharge mRS and National Institute of Health Stroke Scale scores, and lower Barthel Index scores. Factors linked to LTCF admission included higher discharge mRS scores, lower Barthel Index scores, nasogastric tube placement at discharge, and longer hospital stays. Barthel Index scores showed no significant change from admission to discharge in the LTCF group. Stroke severity, post-stroke functional status and nasogastric tube placement are significant predictors of LTCF admission in stroke patients. Early recognition of these factors is crucial for effective discharge planning and reducing the need for institutionalization. The study emphasizes the need for personalized interventions targeting these risk factors to improve patient outcomes and optimize medical resource utilization.

Bridging The Gap: Between an Older Adult Attending The Ambulatory Day Unit and An Acute Hospital Presentation

Abstract Background Older adults attending the ambulatory day units within the hospital group have a comprehensive geriatric assessment (CGA) completed. This identifies the older adult’s functional, physical, social, environmental and psychological baseline, in order to develop and implement a coordinated plan of care and follow up. The CGA is the gold standard in caring for older adults who are frail or at risk of frailty (HSE, 2016). The units are off site from the main hospital, therefore valuable information may not be available to the acute hospital. Valuable information from the CGA can provide the older adult’s functional and cognitive baseline and prevent unnecessary duplication of assessments and increased length of stay. Methods Plan-Do- Study-Act (PDSA) cycle was used. A questionnaire was produced to ascertain acute care staff’s understanding of; whether an older adult is attending the ambulatory unit? Would this information and a review by the RANP Gerontology be beneficial? A Registered Advanced Nurse Practitioner (RANP) Gerontology Pathway was developed. Education was provided to nursing, and the wider multidisciplinary team. An alert sheet was introduced and provided to older adult attending the ambulatory day units. The alert was for the older adult to produce, if attending or admitted to the acute hospital. This initiates the RANP pathway. Older adults are then seen by the RANP at source of admission. Clinic letters with baseline is documented in the Healthcare record, including advice plan and follow-up. Post-implementation questionnaire and verbal feedback were obtained. Results Positive feedback from older adults, family and staff. Avoidance of unnecessary duplication of assessments, data sharing, optimization of plan of care, treatment and rehabilitation potential. Effective discharge planning, reduction of unnecessary transfer to residential care. Conclusion Bridging the gap promotes positive outcomes: Reducing length of stay, positive impact on overall wellbeing, and an organizational cost containment.

Optimizing Stroke Care Transitions: A Patient-Centered Discharge Program for Caregivers

Inadequate discharge planning can worsen long-term outcomes for patients with stroke, delaying their recovery. Equipping caregivers with the knowledge to manage rehabilitation needs is crucial for facilitating a smooth hospital-to-home transition. The study aims to assess the effectiveness of a “Patient-Centered Discharge Program for Caregivers” on the comprehensiveness and clarity of discharge advice provided to caregivers of stroke survivors. Using a quasi-experimental design, the study compared a control group receiving standard discharge planning and an experimental group receiving the “Patient-Centered Discharge Program for Caregivers.” 62 caregivers of stroke survivors formed the participant pool. The program focused on various comprehensive discharge advice domains delivered to the caregivers. The discharge advice, knowledge, and skills of caregivers regarding stroke care were assessed on the day of discharge through questionnaires and checklists. Compared to the control group, the discharge instructions of the experimental group became more comprehensive and clear, with a significant improvement in knowledge and skills regarding stroke care ( p < .05). The knowledge scores of the caregivers showed a statistically significant difference from the control group, with a mean difference of 8.78. ( p < .05). The experimental group demonstrated good skills in nearly all procedures compared to the control group, including oral care, range of motion exercises, feeding, suctioning, and back care ( p < .05). The “Patient-Centered Discharge Program for Caregivers” led to the delivery of more comprehensive discharge instructions, subsequently increasing caregivers’ knowledge. It highlights the benefits of such programs in equipping caregivers for effective discharge planning, with future research needed to evaluate long-term benefits. Trial/Protocol Registration: Clinical Trials Registry India (CTRI) CTRI/2023/07/055602 Link: https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=89913&EncHid=35558.64662&modid=1&compid=19

Perception of Efficiency in Care: A Study of Time Management and Discharge Planning from Nurses and Patients in Hospital Medical Units

Background: Effective time management and efficient discharge planning are crucial for high-quality hospital patient care. This study aimed to understand the perceptions of nurses and patients regarding these aspects to identify areas for improvement. Method: A survey was conducted with 45 nurses and 60 patients in a hospital setting. The nurses’ surveys focused on their experiences with call bell responsiveness, medication administration, and discharge planning. Patient surveys evaluated their perception of nurses’ responsiveness and involvement in the discharge process. Statistical analysis, including ANOVA and correlation tests, was used to assess the data. Results: Nurses reported mixed experiences with call bell response times and varied capabilities for timely medication administration. Challenges included disruptions from call bells, delays in medication delivery, and constraints in discharge discussions and planning. In contrast, patients generally viewed nurses as prompt and attentive, with satisfactory timeliness of care. However, patients expressed dissatisfaction with discharge education. No significant correlations were found between the demographics and perceptions of either group. Conclusion: This study highlights the disparity between nurses' experiences and patients' perceptions of hospital time management and discharge planning. It underscores the need for improved processes and communication strategies to align nurses’ capabilities with patients’ expectations, thereby enhancing overall patient care and satisfaction.

Virtual Interprofessional Education: Team Collaboration in Discharge Planning Simulation.

This study assessed the effectiveness of a virtual interprofessional education (IPE) discharge planning simulation, focusing on collaborative patient education, and recommendations for hospital discharge. An acute care hospital. The study utilized a virtual IPE discharge planning simulation for health care students from six different programs. The simulation involved prebriefing, icebreaker, team meeting, patient interaction, and debriefing. Assessment included pre- and post-IPE surveys that included the Interprofessional Education Collaborative (IPEC) Competency Self-Assessment Tool, and video analysis using the Modified McMaster-Ottawa Rating Scale. Student participants from diverse health care programs ( n =143) included nursing ( n = 20), occupational therapy ( n = 21), physical therapy ( n = 42), physician assistant ( n = 38), respiratory therapy ( n = 3), and social work ( n = 19). All programs except respiratory therapy showed significant improvement in IPEC Competency scores post-IPE, with positive outcomes for understanding other professions' roles. Students' self-reported perceptions of team performance were rated highly in various categories. Video analysis demonstrated strong interrater reliability for team scores. Effective hospital discharge planning is vital for cost reduction and patient care improvement. IPE emphasizes collaborative learning among health care students. Previous studies highlight positive outcomes from IPE discharge planning, including virtual formats. This virtual IPE discharge planning simulation significantly improved students' understanding and collaboration competencies, evident in increased IPEC scores across five professions.

Applying implementation science theories to support practice change in the assessment of cognition by occupational therapists.

Background Understanding cognitive impairments is essential for effective rehabilitation and discharge planning for adults with neurological conditions. The aim of this study was to identify barriers to completing standardised cognitive assessments and evaluate the implementation of an intervention to support practice change. Methods A mixed-methods approach was applied to translate cognitive assessment recommendations into clinical practice using the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation Behaviour model (COM-B) theories. Occupational therapists at one metropolitan health service in Australia were invited to participate. Pre- and post-implementation file audits and surveys were conducted, along with focus groups that collected qualitative data analysed using the TDF and COM-B. Results Survey 1 (n =40) and focus group data (n =24) identified barriers in the TDF domains of knowledge (selection of assessments), environment and resources (equipment and time constraints), and social influences (pressure from other disciplines). To address barriers to implementing a cognitive assessment framework, scripts, cue cards, video-recorded training, and posters were developed as guided by the Behaviour Change Wheel (BCW). Survey 2 showed increased capability to physically administer cognitive assessments (53-74%) and improved clinician understanding of relevant clinical practice guideline (CPG) recommendations (22-50%). File audit data indicated a 30% increase in the number of standardised assessments completed. Conclusions The application of two implementation theories led to the development of an intervention that increased occupational therapists' confidence and their adherence to CPG recommendations. This study serves as a potential model for using the TDF and COM-B to create implementation interventions in various clinical practice areas.

Optimizing the Hospital Discharge Process: Perspectives of the Health Care Team.

Prior research capturing pharmacists' perspectives on the discharge process has shown that their involvement is essential. Given the multidisciplinary nature of the hospital environment, it is important to understand the perspectives of nonpharmacist health care providers. To explore the perspectives of nonpharmacist health care providers concerning current discharge practices, components of an effective discharge plan, and perceived barriers to an optimal discharge, and to explore their expectations of pharmacists at discharge. This qualitative study used key informant interviews of allied health professionals and prescribers at Vancouver General Hospital and North Island Hospital Comox Valley (British Columbia). Participants primarily working on general medicine, family practice, or hospitalist wards were invited to participate. A total of 16 health care providers participated, consisting of 12 allied health professionals and 4 prescribers. Thematic analysis of the interview transcripts revealed 5 themes for each group. The following 3 themes were common to both groups: systems-related barriers to an optimal discharge; patient- and community-related barriers to an optimal discharge; and patient involvement and education. For allied health professionals, themes of prioritization of patients for discharge and direct communication/teamwork were also key for an optimal discharge. Prescriber-specific themes were limitations related to technology infrastructure and inefficiency of existing collaborative processes. Key responsibilities expected of the pharmacist at discharge included preparing the discharge medication reconciliation and prescriptions, addressing medication-related cost concerns, organizing adherence aids/tools, and providing medication counselling. Further studies are warranted to investigate optimization of the discharge process through implementation of standardized discharge protocols and electronic health record-related tools. The primary responsibilities of the pharmacist at discharge, as perceived by study participants, were consistent with previous literature.

Prevalence Of Depressive Symptoms Among Women With Hysterectomy

Background: Depression is the most common psychological problem suffered by women after hysterectomy and is linked to postoperative complications, negative perceptions about body image, femininity, sexual desire, youth, level of energy, and activity, as well as the inability to have children. Methods: A descriptive (Cross-Sectional) design is used in the present study to assess the level of depression among women's after hysterectomy. A Non-probability (purposive) sample consists of sixty women's. The current study was conducted at the Obstetrics and Gynecology Consultant Unit at Al-Zahra Teaching Hospital within Al-Najaf Al-Ashraf Health Directorate in Iraq. Results: Most women after hysterectomy have mild levels of depression (47%). Conclusion:The study found that most women after hysterectomy have depression. Recommendations: Enhancing the psychological and emotional condition of women after hysterectomy by nursing professionals Additionally, coordination between the consultant in obstetrics and Gynecology and the hospital's Department of Psychiatry is needed to reduce depression. And providing an effective discharge plan for women with hysterectomy, including a follow-up visit schedule, the required examinations, and referral numbers for each type of expected complaint after hysterectomy, especially psychological complaints.

The Role of the Surveyor in Discharge Planning for Patient Safety

This article reviews the critical process of patient discharge from hospitals and its challenges, with a focus on the length of stay (LOS) as an indicator of therapeutic success and treatment costs. Emphasis is placed on the importance of accurate diagnosis, appropriate discharge planning, and the prevention of readmissions to the hospital. Utilising the Calgary Family System Theory (CSFT) and the concept of Person-Centered Care (PCC), this piece underscores the significance of an individualised approach, patient involvement in decision-making, effective communication, and multidisciplinary collaboration in the discharge process. Thus, effective discharge planning can enhance the quality of patient care and reduce the economic burden associated with patient readmissions.

The role of collaborative decision-making in discharge planning: Perspectives from patients, family members and health professionals.

To explore discharge planning with a range of key stakeholders in subacute care, including consumers. Qualitative descriptive study. Patients (n = 16), families (n = 16), clinicians (n = 17) and managers (n = 12) participated in semi-structured interviews or focus groups. Following transcription, data were analysed thematically. The overarching facilitator of effective discharge planning was collaborative communication, leading to shared expectations by all stakeholders. Collaborative communication was underpinned by four key themes: patient- and family-centred decision-making, early goal setting, strong inter- and intra-disciplinary teamwork, and robust patient/family education. Effective planning for discharge from subacute care is enabled by shared expectations and collaborative communication between key stakeholders. Effective discharge planning processes are underpinned by effective inter- and intra-disciplinary teamwork. Healthcare networks should foster environments that promote effective communication between and within multidisciplinary team members as well as with patients and their families. Applying these principles to discharge planning may assist in reducing length of stays and rates of preventable readmissions post-discharge. This study addressed a lack of knowledge about effective discharge planning in Australian subacute care. It found that collaborative communication between stakeholders was an overarching facilitator of effective discharge planning. This finding impacts subacute service design and professional education. COREQ guidelines were followed in reporting this study. No patient or public contribution in the design, data analysis or preparation of the manuscript.

Machine learning prediction of hospital patient need for post-acute care using an admission mobility measure is robust across patient diagnoses

ObjectiveOne-fifth of patient discharges from the acute hospital are delayed due to non-medical reasons. Prior research on small specific samples shows that patient mobility is important for predicting post-acute care (PAC) need. Our purpose was to create a disposition prediction model for PAC need in a large, clinically diverse. MethodsA random forest (RF) was constructed to analyze patient admissions at 2 hospitals. The primary outcome was discharge disposition (home or PAC). Predictors included the lowest AM-PAC ‘6-clicks’ mobility score within 48-hours of admission (primary predictor) and demographic and clinical characteristics. A global summary tree was constructed to summarize the RF. ResultsAmong 34,432 patient admissions, the most important variables for predicting PAC placement were AM-PAC, BMI, and age. The AUC was 0.80 (95% confidence interval: 0.79, 0.81). Using a predicted probability for PAC of 0.25 or higher, the sensitivity, specificity and overall accuracy was 76%, 70% and 72%, respectively. Patients 66 years or older with AM-PAC of <31 had the highest probability (0.76) for discharge to PAC. Patients with AM-PAC of >43 had the highest probability for discharge to home. ConclusionsSystematic assessment of inpatients admission mobility should be implemented and used for discharge planning. Electronic medical record systems should be designed to collect and facilitate availability of mobility data on all patients to providers who play key roles in discharge planning. Public Interest SummaryPatient's mobility status during hospitalization has been used to predict their next level of care at discharge, but this work has been done with more limited methods and focused on select patient groups. Using a machine learning technique on thousands of patients with very different medical problems, this study shows that mobility status very early in hospitalization predicts post-acute care (PAC) needs. Based on this study we recommend that early assessment of patient mobility in the hospital should occur for all patients as it can facilitate more effective discharge planning.

Discharge Planning to Improve Readiness Transition Care in-Patient Cerebrovaskuler Accident: A Literature Review

Background: Effective and continuity discharge planning is vital in care continuity and integrated care. Continuity discharge planning can reduce avoidable hospital readmission, and fulfillment improves the quality of care. Prevention efforts to prevent the re-attacks and readmission because of this CVA attack should be started early before the patients return home from the hospital. Purpose: This research aims to review the effect of discharge planning on the readiness of returning home in CVA patients. Methods: We included english materials published between Science Direct, PubMed, Research Gate, and Google Scholar that were used to find studies on discharge planning, readiness, and transitional care between 2016- 2021. Results: Discharge planning is carried out in three-stage, inpatient admission and intra-hospital when the patient is about to be discharged from the hospital. In the first stage, the nurse explains patient admission, regulation, and management when the patient enters the hospital. The second stage is when the patient is hospitalized, which consists of nurses providing education about medication, environment, health, outpatient referral, and diet. While the last stage is when the patient will be discharged, the nurse explains the control, medication, and nutrition schedule at home. Post-stroke rehabilitation and recovery is a chronic process. Conclusion: Review of discharge planning can be influenced by several factors: individual characteristics (clients' potential with special needs early, motivation), family factors (social resources, home environment), and health care system (teaching home care skills with community/ hospital professionals. These factors will affect the implementation of discharge planning in health services which is hospital accreditation.

Načrtovanje odpusta iz psihiatrične bolnišnice iz perspektive socialnih delavk

Planning discharge from a psychiatric hospital from the social workers' perspective Planning discharge is the central task of social workers in a psychiatric hospital. Effective hospital discharge planning is a team process based on assessing needs and finding suitable responses to them. The research results show considerable inconsistency in this area, as the process of discharge planning is initiated at different times. It is especially the users' poor health that does not allow their wishes and needs to be consistently considered, and prevents user participation and autonomy. Consequently, patronizing practices are inevitable. Being treated in a psychiatric hospital is still associated with considerable stigma. The research findings show that social workers feel as equal members of department teams and face plenty of ethical dilemmas at their work. Undergraduate studies have equipped social workers with a wide specter of theoretical and practical knowledge; however, they would like the study programme to be supplemented with health care topics.

A STOMP-focused evaluation of prescribing practices in one assessment and treatment unit for people with intellectual disabilities

PurposeThis study aims to understand whether psychotropic prescribing practices for people with intellectual disabilities are in keeping with best practice guidelines.Design/methodology/approachThis service evaluation project was a retrospective analysis of routinely collected data from the care records of all 36 people with intellectual disability discharged from an intellectual disability assessment and treatment unit during the first five years of the Stop Over medicating People with Intellectual Disabilities and/or autistic people (STOMP) initiative. Data were gathered at four time points (pre-admission, discharge, 6- and 12-month follow-up) before being analysed to understand whether psychotropic prescribing differed among people with different clinical characteristics/traits/diagnoses. Changes over time were also explored to ascertain whether and how prescribing altered from admission to discharge, and over the subsequent year of community living.FindingsMost people with intellectual disabilities left the assessment and treatment unit on fewer regular psychotropic medications and at lower doses than at admission. These optimised regimes were still apparent 12 months post-discharge, suggesting effective discharge planning and community care packages. Inpatients with severe intellectual disabilities generally received more anxiolytics and hypnotics, at higher doses. Autistic people tended to receive more psychotropics in total and at higher cumulative doses, a pattern that persisted post discharge. A third of the sample were admitted on regular anti-psychotic medications despite having no corresponding psychotic diagnosis, a proportion that remained relatively stable through discharge and into the community.Originality/valueThis study highlights subsets of the intellectual disability population at particular risk of receiving high doses of psychotropics and a feasible template for providers intending to undertake STOMP-focused evaluations.

Initial observations on the impact of implementation of a seven-day clinical pharmacy service on dispensary activity and performance

Abstract Introduction The need for seven-day clinical pharmacy services is widely acknowledged, although limited, in the acute sector of the National Health Service.1,2 Timely medicine supply is integral to provision of improved clinical pharmacy services to patients across seven-days, and is essential in effective discharge planning. There is a paucity of evidence for implementation of seven-day clinical pharmacy services, including the impact of service transformation on dispensary activity and performance. This limits planning and development of seven-day pharmacy services. Aim To assess the impact of a seven-day clinical pharmacy service on dispensary activity and performance, at the main site of a tertiary-referral teaching hospital. Methods A seven-day clinical pharmacy service was implemented in October 2021. Prior to this, pharmacy services were largely dispensary-based with clinical pharmacy services for acute and neurosciences admission and limited ward-based services in other specialities. At implementation, clinical pharmacy technicians and pharmacists (n=16) provided patient-facing pharmaceutical care for 7.5-hours/day across all specialities over the weekend; this included medicines reconciliation, preparation of discharge-medication lists, independent prescribing, counselling and clinical review of prioritised patients. The weekend dispensary staffing, skill-mix and shift patterns were redesigned to facilitate staff release from the dispensary rota. Dispensing activity data were obtained from Ascribe for six months pre- and post-implementation (April 2021-March 2022). Data were categorised as inpatient/discharge and the mean number of items dispensed per month analysed using Microsoft Excel. Discharge turnaround performance was calculated as percentage of discharge prescriptions dispensed within two-hours of dispensary receipt and obtained from the Prescription Tracking System. Verbal staff feedback was sought 4-months post-implementation. The study was deemed a service evaluation by the Pharmacy Research and Audit Group and so ethical approval was not required. Results Twelve dispensing staff and one pharmacist were rostered to one of three daily 3.75-hour dispensary shift patterns. Following implementation, mean total inpatient dispensing activity increased from 12799 to 13250 items/month (3.5% increase) and mean weekend activity from 2184 to 2677 items/month (22.6% increase). Mean weekday inpatient activity was stable at 10615 to 10573 items/month. The mean discharge dispensing activity increased from 9065 to 9837 items/month (8.5% increase): mean weekday discharge from 8498 to 8622 items/month (1.5% increase); mean weekend activity from 569 to 1215 items/month (114% increase). Discharge turnaround performance remained stable with 85% discharge prescriptions dispensed within 2-hours, versus 84% pre-implementation. Weekday performance also remained stable - from 84% to 83% and the weekend performance increased from 85% to 92%. Dispensary staff fed-back that weekend shift patterns were effective, activity was manageable and shifts usually ran smoothly and finished on time. Discussion/Conclusion Introduction of a seven-day clinical pharmacy service led to an increase in weekend dispensary activity, which was not offset by decrease in weekday activity. Importantly, the dispensary performance was not negatively impacted and weekend discharge performance improved. Increases could be because of weekend medicines reconciliation, pro-active medication ordering and pharmacist-led preparation of discharge-medicine lists. Dispensary activity in Winter 2020 was atypical because of COVID-19, thus it was not feasible to compare data. Further review, including 12 months data would reduce impact of seasonal variations in NHS activity. Limitations include that patient data including length of stay and time to discharge were not within scope.

The Needs of Orthopaedic Patients in Discharge Planning.

Patients' transition from hospital to home could be challenging for patients and caregivers. This is of utmost importance for patients requiring special or long-term care such as post-orthopaedic surgery. Effective discharge planning is required to ensure that patients are prepared to and get continuous care after returning home to prevent complications. Patients' need assessment is essential to develop effective discharge planning to meet the patient's needs. This mixed-method study aimed to determine the patient's needs to develop a discharge planning for total knee replacement surgery. The needs for 96 total knee replacement patients were assessed using the Needs Evaluation Questionnaire (NEQ). The in-depth interview primary focus was to explore the lived experience of the post-total knee replacement patients receiving care in the hospital. A total of 96 participants (100%) completed the NEQ questionnaire. Most of the needs concerned by the participants were expressed by at least 70% of them except the financial need (59.4%). The semi-structured interview found two elements which were a support group and patients' needs in terms of emotional, physical and spiritual preparation in developing effective discharge planning. This study clarified that the patient needs assessment in the patient care plan.

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.