Planning for Discharge with the Elderly

Simmons, W. June

doi:10.1016/s0097-5990(16)30011-2

Cited by 9 publications

(9 citation statements)

References 3 publications

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“…Iackson involvement in the discharge planning process the more patients perceive themselves. ready for discharge (Coulton et al 1982, Jacobs et al 1985, Simmons 1986). Also, successful outcomes occur more frequently when there is agreement between nurses' assessment and patients' perception of their own needs (Arenth & Mamon 1985, Schaefer et al 1990).…”

Section: Methodsmentioning

confidence: 99%

Discharge planning: issues and challenges for gerontological nursing. A critique of the literature

Jackson

1994

Journal of Advanced Nursing

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Families are rapidly becoming unpaid givers of complex care. Using McKeehan & Coulton's systems model, this critique reviews the evolution of the structure and processes of discharge planning programmes. It explores three common assumptions: discharge planning programmes are cost-effective, allow for enhancement of patients' and families' quality of life, and ensure continuity of care between hospital and community. Funds are saved due to decreased lengths of initial hospital admissions and readmission rates. However, the cost of additional hospital and community resources is rarely considered. Little evidence supports the concept that discharge planning directly affects a patient's health status. Patients and families often do not perceive the same level of benefit from discharge planning as do health professionals. Several issues surrounding research methodologies used in the reviewed studies are identified. Of particular concern is the lack of qualitative research into patients' and families' experiences. The critique concludes with an exploration of ethical issues and challenges arising from increased emphasis on cost-effective discharge planning. These include patients' rights, provision of sufficient human, social and financial resources, improved hospital-community communications, and control over hospital-developed but community-implemented programmes.

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Section: Methodsmentioning

confidence: 99%

Discharge planning: issues and challenges for gerontological nursing. A critique of the literature

Jackson

1994

Journal of Advanced Nursing

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“…Research highlights a number of common discharge-related risks associated, for example, with the management of medicines, the provision of appropriate health and social care, incomplete tests and scans, the fitting and use of home adaptation, and the risks of falls, infections or sores. [17][18][19][20][21][22][23][24][25][26][27][28] The underlying sources of these risks can range from factors related to the patient's condition or comorbidities, to the assessment of patient need, the availability of specialist resources in the community, and wider organisational and cultural factors. For example, research shows that the patient's condition, such as hip fracture, and other comorbidities, especially cognitive function and fragility, can represent a cluster of risks, particularly for older patients, that can complicate the discharge process.…”

Section: Hospital Discharge and Patient Safety: Reviews Of The Literamentioning

confidence: 99%

“…14,24,30,47,53,30,62,94 In general, the recommended use of MDT meetings and national guidelines for initiating social care referrals were strongly followed in all sites. 47,30 At the same time, the findings suggest that slavish adherence to such policies can potentially compromise the ability of stakeholders to work flexibly or to adapt to complex cases, especially patients with comorbidities or complicated personal circumstances.…”

Section: Organisation Factorsmentioning

confidence: 99%

An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge

Waring

Marshall

Bishop

et al. 2014

Health Services and Delivery Research

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BackgroundHospital discharge is a vulnerable stage in the patient pathway. Research highlights communication failures and the problems of co-ordination as resulting in delayed, poorly timed and unsafe discharges. The complexity of hospital discharge exemplifies the threats to patient safety found ‘between’ care processes and organisations. In developing this perspective, safe discharge is seen as relying upon enhanced knowledge sharing and collaboration between stakeholders, which can mitigate system complexity and promote safety.AimTo identify interventions and practices that support knowledge sharing and collaboration in the processes of discharge planning and care transition.SettingThe study was undertaken between 2011 and 2013 in two English health-care systems, each comprising an acute health-care provider, community and primary care providers, local authority social services and social care agencies. The study sites were selected to reflect known variations in local population demographics as well as in the size and composition of the care systems. The study compared the experiences of stroke and hip fracture patients as exemplars of acute care with complex discharge pathways.DesignThe study involved in-depth ethnographic research in the two sites. This combined (a) over 180 hours of observations of discharge processes and knowledge-sharing activities in various care settings; (b) focused ‘patient tracking’ to trace and understand discharge activities across the entire patient journey; and (c) qualitative interviews with 169 individuals working in health, social and voluntary care sectors.FindingsThe study reinforces the view of hospital discharge as a complex system involving dynamic and multidirectional patterns of knowledge sharing between multiple groups. The study shows that discharge planning and care transitions develop through a series of linked ‘situations’ or opportunities for knowledge sharing. It also shows variations in these situations, in terms of the range of actors, forms of knowledge shared, and media and resources used, and the wider culture and organisation of discharge. The study also describes the threats to patient safety associated with hospital discharge, as perceived by participants and stakeholders. These related to falls, medicines, infection, clinical procedures, equipment, timing and scheduling of discharge, and communication. Each of these identified risks are analysed and explained with reference to the observed patterns of knowledge sharing to elaborate how variations in knowledge sharing can hinder or promote safe discharge.ConclusionsThe study supports the view of hospital discharge as a complex system involving tightly coupled and interdependent patterns of interaction between multiple health and social care agencies. Knowledge sharing can help to mitigate system complexity through supporting collaboration and co-ordination. The study suggests four areas of change that might enhance knowledge sharing, reduce system complexity and promote safety. First, knowledge brokers in the form of discharge co-ordinators can facilitate knowledge sharing and co-ordination; second, colocation and functional proximity of stakeholders can support knowledge sharing and mutual appreciation and alignment of divergent practices; third, local cultures should prioritise and value collaboration; and finally, organisational resources, procedures and leadership should be aligned to fostering knowledge sharing and collaborative working. These learning points provide insight for future interventions to enhance discharge planning and care transition. Future research might consider the implementation of interviews to mediate system complexity through fostering enhanced knowledge sharing across occupational and organisational boundaries. Research might also consider in more detail the underlying complexity of both health and social care systems and how opportunities for knowledge sharing might be engendered to promote patient safety in other areas.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…All members of the care team need to be involved (Buckwalter, 1985), and a thorough assessment must be compiled (Besdene, 1988;Hughes, 1989;Simmons, 1986;Wetle, 1988). The ability to implement the discharge process in an effective, timely manner depends in part on the training that planners receive.…”

Section: Discharge Planning Frameworkmentioning

confidence: 99%

What Do Discharge Planners Plan? Implications for Older Medicare Patients

1991

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This research examines the discharge-planning process, specifically assessing the extent to which components critical to effective discharge planning are implemented in acute-care settings. We surveyed 16 discharge planners in rural and metropolitan hospitals. The analysis examined the degree to which discharge-planning programs incorporate client-centered planning activities, collect information about the client's care deficits, use community services to support the client on discharge, and the extent of interdepartment involvement in discharge planning. Results indicated that the majority of planners were client centered in their planning; however, a complete assessment of the client's resources and care deficits did not occur on admission. We discuss implications for discharge planning.

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Planning for Discharge with the Elderly

Cited by 9 publications

References 3 publications

Discharge planning: issues and challenges for gerontological nursing. A critique of the literature

Discharge planning: issues and challenges for gerontological nursing. A critique of the literature

An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge

What Do Discharge Planners Plan? Implications for Older Medicare Patients

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