Use of a quality improvement strategy to introduce co‐design of the mental health discharge plan in rural and remote New South Wales

Abstract

Problem Patients have not traditionally partnered in the design of their discharge plans, with discharge summaries at times not completed. In rural settings, discharge planning communicates care to a complex geographic area with fragmented resources. Patients may also be socially disadvantaged, with relatives and friends sometimes excluded. Design Situational analysis and liaison with key partners occurred in the months prior to the core project. Opportunities for improvement were noted. An audit of all discharges in May 2020 was planned to assess rates of discharge completion, co‐design and inclusion of next of kin. Qualitative feedback was also noted from staff. Setting Dubbo inpatient mental health units (Gundaymarra and Barraminya). Key measures for improvement Rates of discharge summary completion, co‐design of discharge plan, engagement of next of kin. Qualitative measures included reflections of clinical staff involved. Strategy for change Junior doctors were key in facilitating each patient to co‐design their discharge plan and collaborate with all biological and psychosocial treatments and providers in a forum for open discussion. The inclusion of nominated next of kin was core. Effects of change Discharge summary completion rates were high; co‐design of discharge plans occurred frequently; and next of kin were involved with few exceptions. The adoption of the person as expert in modifying their plan became a norm. Medical staff wanted this care frame for each person. Lessons learnt Engaging patients and their next of kin directly in their discharge planning improves care opportunities in a rural setting, as well as understanding for all parties. This approach also prioritises the process of discharge completion.

Hospital doctors’ and general practitioners’ perspectives of outpatient discharge processes in Australia: an interpretive approach

“…Given the large number of people involved in the discharge process, it appears that improving the discharge process, including implementing discharge principles, requires involvement and education of all stakeholders, including hospital specialists, junior doctors, nurses, administrative staff, GPs and patients, to ensure all parties are aware of and comfortable with the process. Some participants argued that discharge principles and policies should be co-designed between hospitals and general practice to improve usability, uptake, and adherence by all stakeholders [6,25].…”

Evaluating the Co-design of an Age-Friendly, Rural, Multidisciplinary Primary Care Model: A Study Protocol

“…Evidence from diverse international contexts suggests that the use of participatory design approaches, such as the one being applied in this study, can improve organisational efficiency and improve patient experience [ 33 , 49 ]. This study will contribute to the body of literature examining the efficacy of co-design in rural contexts [ 50 , 51 ] and in relation to the design of services and supports for older people [ 52 , 53 ].…”

A Scoping Review of Adult Experiences of Hospital to Home Transitions in Rural Settings

“…The third point of discussion are the missed opportunities to draw attention to the rural context during transitions. It is particularly important in rural settings that patients and next of kin are included in discharge planning due to their knowledge of potentially accessible local resources (Kealy-Bateman et al, 2021). A recent Canadian model was developed for rural primary health care (PHC) management of dementia, noting that rural settings are different than urban, lack adequate services, struggle with physician recruitment and retention, and that there is "tremendous diversity across rural settings and PHC teams" (Morgan et al, 2019, p. 2).…”