Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement (original) (raw)
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Identifying barriers to improving the process of discharging patients from hospital
Primary Health Care Research and Development, 2003
Objective: To identify the barriers to successful discharge practices in a general hospital medical service. Design: Focus groups with health professionals and in depth interviews with patients were used to identify and explore themes arising from the concept of a good discharge. Thematic analysis was undertaken to identify and link the concepts highlighted. Subjects: Four focus groups (four to ten participants) and ten in depth interviews were conducted. Purposive sampling was used to capture a full range of views. Main outcome measures: Themes arising from the focus groups and interviews were analysed to examine barriers to effective discharge practice. Results: Five major themes emerged from the focus group data including; 1) Communication, 2) Teamwork and Roles, 3) The process of discharge and coordination 4) Resources, and 5) Time. Patients discussed their experiences, concerns and lack of knowledge, of the discharge process. Conclusion: The barriers to in uencing the discharge process were shown to be complex and interrelated. The way, in which teams work together is an important factor, which appears not to have been addressed in research into discharge interventions. No single strategy or intervention is likely to be successful in changing discharge practice. Future research to improve discharge should focus on combinations of strategies that target local barriers at the level of the individual, team and organization.
Health & Social Care in the Community, 2007
In recent years, there has been significant concern, and policy activity, in relation to the problem of delayed discharges from hospital. Key elements of policy to tackle delays include new investment, the establishment of the Health and Social Care Change Agent Team, and the implementation of the Community Care (Delayed Discharge) Act 2003. Whilst the problem of delays has been widespread, some authorities have managed to tackle delays successfully. The aim of the qualitative study reported here was to investigate discharge practice and the organisation of services at sites with consistently low rates of delay, in order to identify factors supporting such good performance. Six 'high performing' English sites (each including a hospital trust, a local authority, and a primary care trust) were identified using a statistical model, and 42 interviews were undertaken with health and social services staff involved in discharge arrangements. Additionally, the authors set out to investigate the experiences of patients in the sites to examine whether there was a cost to patient care and outcomes of discharge arrangements in these sites, but unfortunately, it was not possible to secure sufficient patient participation. Whilst acknowledging the lack of patient experience and outcome data, a range of service elements was identified at the sites that contribute to the avoidance of delays, either through supporting efficiency within individual agencies or enabling more efficient joint working. Sites still struggling with delays should benefit from knowledge of this range. The government's reimbursement scheme appears to have been largely helpful in the study sites, prompting efficiency-driven changes to the organisation of services and discharge systems, but further focused research is required to provide clear evidence of its impact nationally, and in particular, how it impacts on staff, and patients and their families.
A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent
Critical Social Policy, 2022
Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical Systems Heuristics framework to examine the implementation process and focuses in particular on why this improvement project proved to be so difficult to implement and why the anticipated outcomes were so elusive. The analysis highlights the value in using critical systems thinking to better evaluate integrated care initiatives, in particular by identifying more explicitly different stakeholder perspectives and power relationships within the system and its decision environment.
Background There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge. Methods The Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance. Results Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change. Conclusions This study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.
Re-engineering the Hospital Discharge: An Example of a Multifaceted Process Evaluation
2000
Introduction: The transfer of patient care from the hospital team to primary care and other providers in the community at the time of discharge is a high-risk process characterized by fragmented, nonstandardized, and haphazard care that leads to errors and adverse events. The development of interventions to improve the discharge process requires a detailed evaluation of the process by a
BMC Health Services Research, 2023
Background Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient's readiness for discharge places a heavy reliance on a clinician's judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians' perspectives and in the acute care setting. This paper aimed to explore the perceptions of dischargereadiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers. Methods A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audiorecorded. Following transcription, inductive thematic analysis was completed. Results Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors). Conclusions These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients' discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention.
Lost in translation: reviewing the role of the discharge liaison nurse in Wales
Health Services Management Research, 2010
In Wales, the National Leadership and Innovation Agency in Healthcare (NLIAH) Change Agent Team (CAT) has found that its service improvement methodology of Communities of Practice (CoP), where motivated frontline staff in health and social care come together to share issues and develop solutions to mutual problems, is a highly effective and informative tool. Health and social care organizations in Wales are in the process of working to develop processes and solutions to remedy the challenges they have over patients with long lengths of stay. This article shows how by speaking to the frontline staff, whose role it is to help people whose discharge is likely to be complex or problematic, they often have most insight into the solutions required to alleviate the situation. The learning in this article is that there is no one solution to improve the discharge process; however there are a number of small changes and improvements required, which if done consistently can have a significant ...
Journal of integrated care, 2024
Purpose-To facilitate the reception and care of discharged patients, streamlining processes at the University Hospital and promoting a seamless transition to continuity of care services post-discharge. Design/methodology/approach-Hospitalised patients undergo the Blaylock risk assessment screening score (BRASS), a screening tool identifying those at risk of complex discharge. Findings-Pre-pandemic, patients with a medium-to-high risk of complex discharge were predominantly discharged to their residence or long-term care facilities. During the pandemic, coinciding with an overall reduction in hospitalisation rates, there was a decrease in patients being discharged to their residence. Originality/value-The analysis of discharges, with the classification of patients into risk groups, revealed a coherence between the BRASS score and the characteristics of the studied sample. This tool aids physicians in decision-making by identifying the need for a planned discharge in a systematic and organised manner, preventing the loss of crucial information.
The process of hospital discharge for medical patients: a model
Journal of Advanced Nursing, 2004
The process of hospital discharge for medical patients: a model Background. The 1990 NHS Community Care Act established a requirement for hospital discharge policies and procedures in the United Kingdom to be developed in collaboration with local government authorities in order to ensure supported discharge for those in need. Aims. The aim of the study reported in this paper was to track decisions about hospital discharge in relation to outcomes for a sample of medical patients and their carers, identified as at risk of experiencing unsuccessful discharge processes. Methods. Themed unstructured interviews were conducted in three different hospitals with 30 patients identified as at risk of unsuccessful discharge and their carers pre-and postdischarge. Hospital, community and social care staff involved in the care of the patient were also interviewed. Findings. Patients and carers were constantly negotiating their social roles, seeking to juggle appropriate identities and limited resources to maintain their own and each others' dignity and quality of life. When the negotiation process was destabilized (for example, by exacerbation of chronic disease, withdrawal of some resource, or the experience of additional stressors -not necessarily health-related), then either or both parties sought a way out. In all the cases examined the result was admission to hospital -usually, but not always, mediated by community professionals. Conclusions. The effective discharge of patients from hospital needs to move from a functional focus on symptom management to a negotiation of quality of life that seeks to promote health for all parties involved.