Developing Best Practice Guidance for Discharge Planning Using the RAND/UCLA Appropriateness Method

Abstract

Background: Discharge from acute mental health inpatient units is often a vulnerable period for patients. Multiple professionals and agencies are involved and processes and procedures are not standardized, often resulting in communication delays and co-ordination failures. Early and appropriate discharge planning and standardization of procedures could make inpatient care safer.Aim: To inform the development of a multi-component best practice guidance for discharge planning (including the 6 component SAFER patient flow bundle) to support safer patient transition from mental health hospitals to the community.Methods: Using the RAND/UCLA Appropriateness method, a panel of 10 professional stakeholders (psychiatrists, psychiatric nurses, clinical psychologists, pharmacists, academics, and policy makers) rated evidence-based statements. Six hundred and sixty-eight statements corresponding to 10 potential components of discharge planning best practice were rated on a 9-point integer scale for clarity, appropriateness and feasibility (median ≥ 7–9) using an online questionnaire then remote online face-to-face meetings.Results: Five of the six “SAFER” patient flow bundle components were appropriate and feasible for inpatient mental health. One component, “Early Flow,” was rated inappropriate as mental health settings require more flexibility. Overall, 285 statements were rated as appropriate and feasible. Forty-four statements were considered appropriate but not feasible to implement.Discussion: This consensus study has identified components of a best practice guidance/intervention for discharge planning for UK mental health settings. Although some components describe processes that already happen in everyday clinical interactions (i.e., review by a senior clinician), standardizing such processes could have important safety benefits alongside a tailored and timely approach to post-discharge care.

Evaluating a co-designed care bundle to improve patient safety at discharge from adult and adolescent mental health services (SAFER-MH and SAFER-YMH): protocol for a non-randomised feasibility study

“…Therefore, interventions aiming to improve knowledge sharing, shared decision-making and involvement of patients/carers are considered preferable. 21 23 32 This study will determine the feasibility and acceptability of a multicomponent intervention to improve involvement of patients and/or carers in discharge planning. This will provide evidence for the acceptability of the SAFER-MH and SAFER-YMH to inform future improvements to scale to an RCT, with concurrent process evaluation and economic evaluation.…”

“…The intervention was adapted based on 35 stakeholder interviews and RAND consensus methods with multidisciplinary experts and professionals. 21 22 SAFER-YMH involved a further level of co-design to ensure that the intervention is suitable for adolescent services. This involved presenting the adult version to professional and patient groups to discuss relevant changes to be made to make it more appropriate to adolescent services.…”

“…The SAFER-MH is a co-designed adapted version of the SAFER patient flow bundle (NHS Improvement) intervention18 and will be delivered to patients as part of their normal care pathway. The intervention was adapted based on 35 stakeholder interviews and RAND consensus methods with multidisciplinary experts and professionals 21 22. SAFER-YMH involved a further level of co-design to ensure that the intervention is suitable for adolescent services.…”

“…To address this gap, we conducted a series of co-design empirical studies with multiple stakeholders including patients, carers, professionals and academics. 21 22 These led to the development of two adapted versions of the SAFER patient flow bundle tailored to mental health, one for an adult acute psychiatric hospital (SAFER-MH) and one for youth (child and adolescent) mental health services (SAFER-YMH). Now that the bundle has been developed, we aim to generate data regarding its feasibility and acceptability, which will enrich the evidence base about its future wider adoption in NHS.…”

“…Although protocols, webinars, and/or other tools have been developed to facilitate the implementation of SAFER,20 there is currently lack of evidence examining its appropriateness within a mental health setting. To address this gap, we conducted a series of co-design empirical studies with multiple stakeholders including patients, carers, professionals and academics 21 22. These led to the development of two adapted versions of the SAFER patient flow bundle tailored to mental health, one for an adult acute psychiatric hospital (SAFER-MH) and one for youth (child and adolescent) mental health services (SAFER-YMH).…”