Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study

Abstract

ObjectivesTrauma and acute care surgery (TACS) patients face complex barriers associated with hospitalization discharge that hinder successful recovery. We sought to better understand the challenges in the discharge transition of care, which might suggest interventions that would optimize it.MethodsWe conducted a qualitative study of patient and clinician perceptions about the hospital discharge process at an urban level 1 trauma center. We performed semi-structured interviews that we recorded, transcribed, coded both deductively and inductively, and analyzed thematically. We enrolled patients and clinicians until we achieved data saturation.ResultsWe interviewed 10 patients and 10 clinicians. Most patients (70%) were male, and the mean age was 57±16 years. Clinicians included attending surgeons, residents, nurse practitioners, nurses, and case managers. Three themes emerged. (1) Communication (patient-clinician and clinician-clinician): clinicians understood that the discharge process malfunctions when communication with patients is not clear. Many patients discussed confusion about their discharge plan. Clinicians lamented that poorly written discharge summaries are an inadequate means of communication between inpatient and outpatient clinicians. (2) Discharge teaching and written instructions: patients appreciated discharge teaching but found written discharge instructions to be overwhelming and unhelpful. Clinicians preferred spending more time teaching patients and understood that written instructions contain too much jargon. (3) Outpatient care coordination: patients and clinicians identified difficulties with coordinating ongoing outpatient care. Both identified the patient’s primary care physician and insurance coverage as important determinants of the outpatient experience.ConclusionTACS patients face numerous challenges at hospitalization discharge. Clinicians struggle to effectively help their patients with this stressful transition. Future interventions should focus on improving communication with patients, active communication with a patient’s primary care physician, repurposing, and standardizing the discharge summary to serve primarily as a means of care coordination, and assisting the patient with navigating the transition.Level of evidenceIII—descriptive, exploratory study.

Trauma Patient-Centered Discharge Plan Form: A Pilot Study

“…The pilot study also introduced a new trauma APP role. Previous research has shown that when trauma APPs are incorporated into the trauma team and entrusted with managing the multidisciplinary discharge planning process, they can interact with patients and families, serve as the main liaison and advocate for nursing-related concerns, and provide leadership, mentorship, and teaching to bedside nurses caring for trauma patients (Collins et al, 2014;Crawford, 2019;McFadden et al, 2022). In a study of Medicare beneficiaries, Meddings et al (2023) found that patients who had an APP involved in their care had a reduced risk of readmission to the hospital.…”

Discharge Planning Carried Out by Nurses to Increase Caregivers' Competence: A Clinical Trial

“…The data from this study showed that the most significant increases in the care competence occurred after the guidelines and training provided in the hospital environment and at the end of followup in the Intervention Group. It is known that the educational strategies aimed at instrumentalizing informal caregivers described in the literature were successful 4,[7][8]12,21 . However, the results of this clinical trial, supported by data from the pilot study 5 , reinforce that providing health guidelines only in the hospital without proper monitoring at home is not sufficient to sustain the caregivers' competence after discharge.…”

“…An initial and ongoing assessment of the dyad is essential for planning and implementing strategies to support clients and their family [22][23] and, thus, promote care continuity. Such moment provides time and support for discharge planning, anticipating conditions that may occur at home, enabling those involved to deal with the functional decline of their family members, in addition to determining the caregiver's psychological readiness to promote active involvement in decision-making and ease the education required for health self-management 12,23 . Secondly, in the home environment, the interventions should be based on experiences and difficulties adapting to the role of caregiver 1 .…”

“…However, nurses' training has been shown to be insufficient for the development of competencies to carry out the discharge process, which is aggravated by high turnover and rush to free up beds, negatively compromising the time and quality given to guidelines. It becomes important for nurses to actively engage in the discharge planning process, collaboratively with the multiprofessional team, taking into account the unique needs of each caregiver and dependent individual, as well as fostering improved communication between services and referrals in the health system 12 .…”

“…Discharge planning from hospital to home is also little reported in the Brazilian literature, generating fragmentation in post-discharge care. When it does occur, it typically takes place in an initial or rudimentary manner 3 , causing caregivers to not feel supported and lack sufficient information about their family member's health condition and treatment [8][9][11][12][13] .…”