Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives

BMC Health Services Research

Research

Natasha A Lannin¹  Lisa Hanna²  Kate Gledhill³  Tracey K Bucknall⁴ 

[1] Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia;Alfred Health, Melbourne, Australia;School of Health and Social Development, Deakin University, Geelong, Australia;Institute of Health Transformation, Deakin University, Geelong, Australia;School of Health and Social Development, Deakin University, Geelong, Australia;School of Primary and Allied Healthcare, Monash University, Frankston, Australia;Department of Occupational Therapy, School of Primary Health and Allied Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, 3199, Frankston, VIC, Australia;School of Nursing and Midwifery, Deakin University, Melbourne, Australia;Alfred Health, Melbourne, Australia;Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Australia;

关键词: Clinical decision-making;    Patient readmission;    Length of stay;    Patient discharge;    Qualitative;    Sub-acute Care;   

DOI  :  10.1186/s12913-023-09285-y

 received in 2022-08-25, accepted in 2023-03-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPlanning 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 discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers.MethodsA 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 audio-recorded. Following transcription, inductive thematic analysis was completed.ResultsParticipants 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).ConclusionsThese 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.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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