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Pedersen MK, Mark E, Uhrenfeldt L. Hospital readmission: Older married male patients' experiences of life conditions and critical incidents affecting the course of care, a qualitative study. Scand J Caring Sci 2018; 32:1379-1389. [PMID: 29920715 DOI: 10.1111/scs.12583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the frequency of hospital readmissions, there is still a relatively incomplete understanding of the broader array of factors pertaining to readmission in older persons. Few studies have explored how older persons experience readmission and their perceptions of circumstances affecting the course of care. Research indicates that males experience poorer health outcomes and are at higher risk of readmission compared to women. AIM To explore life conditions and critical incidents pertained to hospital readmission from the perspective of older males. METHODS The study used a qualitative explorative design using the Critical Incident Technique. A purposive sample of four males aged 65-75 were recruited from two internal medical wards. Data were collected through narrative double interviews. The study was registered by the North Denmark Region's joint notification of health research (ID 2008-58-0028). FINDINGS The analysis revealed four themes of life conditions: 'Ambiguity of ageing', 'Living with the burden of illness', 'Realisation of dependency' and 'Growing sense of vulnerability and mortality'. Critical incidents comprised four areas: 'Balancing demands and resources in everyday life', 'Back home again - a period of recovery', 'Care interaction' and 'Navigating within and between healthcare system(s)'. CONCLUSION This study illustrated the interconnectedness, dynamics and complexity of life conditions and critical incidents that over time and across diverse healthcare sectors affected the course of care in older persons. Hospital readmissions seem related to a complex web of interacting life conditions and critical incidents rather than growing age or specific illnesses.
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Affiliation(s)
- Mona Kyndi Pedersen
- Clinic for Internal Medicine, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Edith Mark
- Clinic for Internal Medicine, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Lisbeth Uhrenfeldt
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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2
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Coombs MA, Parker R, de Vries K. Managing risk during care transitions when approaching end of life: A qualitative study of patients' and health care professionals' decision making. Palliat Med 2017; 31:617-624. [PMID: 28618896 PMCID: PMC5476192 DOI: 10.1177/0269216316673476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increasing importance is being placed on the coordination of services at the end of life. AIM To describe decision-making processes that influence transitions in care when approaching the end of life. DESIGN Qualitative study using field observations and longitudinal semi-structured interviews. SETTING/PARTICIPANTS Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and Palliative Care Indicators Tool was used to identify participants with advanced and progressive illness. Patients and family members were interviewed on recruitment and 3-4 months later. Four weeks of fieldwork were conducted in each site. A total of 40 interviews were conducted: 29 initial interviews and 11 follow-up interviews. Thematic analysis was undertaken. FINDINGS Managing risk was an important factor that influenced transitions in care. Patients and health care staff held different perspectives on how such risks were managed. At home, patients tolerated increasing risk and used specific support measures to manage often escalating health and social problems. In contrast, decisions about discharge in hospital were driven by hospital staff who were risk-adverse. Availability of community and carer services supported risk management while a perceived need for early discharge decision making in hospital and making 'safe' discharge options informed hospital discharge decisions. CONCLUSION While managing risk is an important factor during care transitions, patients should be able to make choices on how to live with risk at the end of life. This requires reconsideration of transitional care and current discharge planning processes at the end of life.
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Affiliation(s)
- Maureen A Coombs
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Roses Parker
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
| | - Kay de Vries
- School of Health Sciences, University of Brighton, Brighton, UK
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3
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Burridge L, Mitchell G, Jiwa M, Girgis A. Helping lay carers of people with advanced cancer and their GPs to talk: an exploration of Australian users' views of a simple carer health checklist. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:357-365. [PMID: 26694537 DOI: 10.1111/hsc.12312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 06/05/2023]
Abstract
The lay caregiving role is integral to advanced cancer care but places carers' health at risk. A supportive General Practitioner (GP) can help primary lay carers manage their health, if they disclose their concerns. A Needs Assessment Tool for Caregivers (NAT-C) was developed for carers to self-complete and use as the basis of a GP consultation, then tested in a randomised controlled trial. This paper reports a qualitative research study to determine the usefulness and acceptability of the NAT-C in the Australian primary care setting. Convenience samples of 11 carers and 5 GPs were interviewed between September 2010 and December 2011 regarding their experiences with and perceptions of the NAT-C. Open-ended questions were used, and the transcripts were analysed qualitatively to identify themes and patterns. Three major themes were identified: (a) Acceptability of the intervention; (b) Impact of the intervention on the GP-patient relationship; and (c) Place of the intervention in advanced cancer care. This simple checklist was acceptable to carers, although some were uncertain about the legitimacy of discussing their own needs with their GP. Carer-patients could not be certain whether a GP would be willing or equipped to conduct a NAT-C-based consultation. Such consultations were acceptable to most GPs, although some already used a holistic approach while others preferred brief symptom-based consultations. Although the NAT-C was acceptable to most carers and GPs, supportive consultations take time. This raises organisational issues to be addressed so carers can seek and benefit from their GP's support.
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Affiliation(s)
- Letitia Burridge
- School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospitals, Herston, Queensland, Australia
| | - Geoffrey Mitchell
- School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospitals, Herston, Queensland, Australia
| | - Moyez Jiwa
- School of Medicine Sydney, Melbourne Clinical School, University of Notre Dame, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
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Allen J, Hutchinson AM, Brown R, Livingston PM. User Experience and Care Integration in Transitional Care for Older People From Hospital to Home: A Meta-Synthesis. QUALITATIVE HEALTH RESEARCH 2017; 27:24-36. [PMID: 27469975 DOI: 10.1177/1049732316658267] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This meta-synthesis aimed to improve understanding of user experience of older people, carers, and health providers; and care integration in the care of older people transitioning from hospital to home. Following our systematic search, we identified and synthesized 20 studies, and constructed a comprehensive framework. We derived four themes: (1) 'Who is taking care of what? Trying to work together"; (2) 'Falling short of the mark'; (3) 'A proper discharge'; and (4) 'You adjust somehow.' The themes that emerged from the studies reflected users' experience of discharge and transitional care as a social process of 'negotiation and navigation of independence (older people/carers), or dependence (health providers).' Users engaged in negotiation and navigation through the interrogative strategies of questioning, discussion, information provision, information seeking, assessment, and translation. The derived themes reflected care integration that facilitated, or a lack of care integration that constrained, users' experiences of negotiation and navigation of independence/dependence.
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Affiliation(s)
| | - Alison M Hutchinson
- Deakin University, Burwood, Victoria, Australia
- Monash Health, Clayton, Victoria, Australia
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5
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Welch A, Lowes S. Home Assessment Visits within the Acute Setting: a Discussion and Literature Review. Br J Occup Ther 2016. [DOI: 10.1177/030802260506800403] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The emphasis on the effective and efficient use of finite resources within acute hospitals has led to close attention being paid to the length of patients' hospital stay and the assessment of risk in facilitating timely hospital discharge. Occupational therapy home assessment visits are valued by the multidisciplinary team as a means of assessing a patient's level of function and environmental risk to ensure safe discharge from hospital. Occupational therapists' education and training and experience mean that they are well placed to predict levels of function postdischarge and to anticipate any problems that may occur in activities of daily living. However, for patients the home assessment visit can be a stressful and bewildering experience. The short-term focus on equipment provision combined with limited postdischarge intervention may not meet patient and carer expectations or concerns with longer-term issues. Although there is a body of evidence to support this intervention, the requirement for evidence-based practice means that there is a need for additional research around the areas of optimal timing, selection of patient groups, therapist's rationale, patient and carer perspectives and any effect that home assessments may have on readmission rates. This paper discusses the literature in relation to the practice of home assessment visits from the acute setting.
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Abstract
CONTEXT While the patient-carer dyad has been broadly described, there is little exploration of patient-carer models in use. AIM To explore types of patient-carer models in use for those with advanced and progressive disease. METHODS Qualitative interviews were undertaken with patients at risk of dying in the next year and their carers across three sites (residential care home, medical assessment unit, general medical unit). Thematic analysis was undertaken. RESULTS Four patient-carer models were identified. In these, the provision of care and of coordination of care services were important areas and organised differently across the patient, the carer, and alternative sources of support. CONCLUSION A 'one size fits all' patient-carer model is outdated and a new understanding of different types of patient-carer models are required to fully inform care delivered at end of life.
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Affiliation(s)
- Roses Parker
- Research Assistant, Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
| | - Kay deVries
- Deputy Head, School of Health Sciences, University of Brighton, Brighton, UK
| | - Maureen A Coombs
- Professor of Clinical Nursing (Critical Care), Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Capital and Coast District Health Board, Wellington
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7
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Darby J, Williamson T, Logan P, Gladman J. Comprehensive geriatric assessment on an acute medical unit: a qualitative study of older people's and informal carer's perspectives of the care and treatment received. Clin Rehabil 2016; 31:126-134. [PMID: 26801585 DOI: 10.1177/0269215515624134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This qualitative study was imbedded in a randomized controlled trial evaluating the addition of geriatricians to usual care to enable the comprehensive geriatric assessment process with older patients on acute medical units. The qualitative study explored the perspectives of intervention participants on their care and treatment. DESIGN A constructivist study incorporating semi-structured interviews that were conducted in patients' homes within six weeks of discharge from the acute medical unit. These interviews were recorded, transcribed, and analysed using thematic analysis. SETTING An acute medical unit in the United Kingdom. PARTICIPANTS Older patients ( n = 18) and their informal carers ( n = 6) discharged directly home from an acute medical unit, who had been in the intervention group of the randomized controlled trial. RESULTS Three core themes were constructed: (1) perceived lack of treatment on the acute medical unit; (2) nebulous grasp of the role of the geriatrician; and (3) on-going health and activities of daily living needs postdischarge. These needs impacted upon the informal carers, who either took over, or helped the patients to complete their activities of daily living. Despite the help received with activities of daily living, a lot of the patients voiced a desire to complete these activities themselves. CONCLUSIONS The participants perceived they were just monitored and observed on the acute medical unit, rather than receiving active treatment, and spoke of on-going unresolved health and activity of daily living needs following discharge, despite receiving the additional intervention of a geriatrician.
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Affiliation(s)
- Janet Darby
- 1 School of Medicine, University of Nottingham, Nottingham, UK
| | - Tracey Williamson
- 2 School of Nursing, Midwifery, Social Work & Social Sciences, University of Salford, Salford, UK
| | - Pip Logan
- 1 School of Medicine, University of Nottingham, Nottingham, UK.,3 Community Rehabilitation, Nottingham City Primary Care Trust, Nottingham, UK
| | - John Gladman
- 1 School of Medicine, University of Nottingham, Nottingham, UK
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8
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Gabrielsson-Järhult F, Nilsen P. On the threshold: older people's concerns about needs after discharge from hospital. Scand J Caring Sci 2015; 30:135-44. [DOI: 10.1111/scs.12231] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Per Nilsen
- Division of Community Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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9
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Maneze D, Dennis S, Chen HY, Taggart J, Vagholkar S, Bunker J, Liaw ST. Multidisciplinary care: experience of patients with complex needs. Aust J Prim Health 2014; 20:20-6. [PMID: 23021199 DOI: 10.1071/py12072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/03/2012] [Indexed: 11/23/2022]
Abstract
The rapidly increasing prevalence of diabetes with its high morbidity and mortality raises the need for an integrated multidisciplinary service from health care providers across health sectors. The aim of this study was to explore the diabetic patients' experience of multidisciplinary care, in particular their perceptions, perceived barriers and facilitators. Thirteen patients with type-2 diabetes admitted to the emergency department of a local hospital in NSW were interviewed and completed a demographic questionnaire. Results showed that patients found it inconvenient to be referred to many health professionals because of multiple physical and psychosocial barriers. Separate sets of instructions from different health professionals were overwhelming, confusing and conflicting. Lack of a dedicated coordinator of care, follow up and support for self-management from health professionals were factors that contributed to patients' challenges in being actively involved in their care. The presence of multiple co-morbidities made it more difficult for patients to juggle priorities and 'commitments' to many health professionals. In addition, complex socioeconomic and cultural issues, such as financial difficulties, lack of transport and language barriers, intensified the challenge for these patients to navigate the health system independently. Few patients felt that having many health professionals involved in their care improved their diabetes control. Communication among the multidisciplinary care team was fragmented and had a negative effect on the coordination of care. The patients' perspective is important to identify the problems they experience and to formulate strategies for improving multidisciplinary care for patients with diabetes.
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Affiliation(s)
- Della Maneze
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia
| | - Sarah Dennis
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia
| | - Huei-Yang Chen
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia
| | - Jane Taggart
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia
| | - Sanjyot Vagholkar
- South Western Sydney Local Health District General Practice Unit, PO Box 5, Fairfield, NSW 1860, Australia
| | - Jeremy Bunker
- South Western Sydney Local Health District General Practice Unit, PO Box 5, Fairfield, NSW 1860, Australia
| | - Siaw Teng Liaw
- South Western Sydney Local Health District General Practice Unit, PO Box 5, Fairfield, NSW 1860, Australia
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10
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Kangovi S, Grande D, Meehan P, Mitra N, Shannon R, Long JA. Perceptions of readmitted patients on the transition from hospital to home. J Hosp Med 2012; 7:709-12. [PMID: 23212980 DOI: 10.1002/jhm.1966] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/20/2012] [Accepted: 07/05/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hospital leaders have had mixed success reducing readmissions Little is known about the readmitted patient's perspective. METHODS A cross-sectional 36-item survey was administered to 1084 readmitted inpatients of The Hospital of the University of Pennsylvania (an urban academic medical center) and Penn Presbyterian Medical Center (an urban community hospital) between November 10, 2010 and July 5, 2011. The survey response rate was 32.9%. RESULTS The most commonly reported issues contributing to readmission were: 1) feeling unprepared for discharge (11.8%); 2) difficulty performing activities of daily living (ADLs) (10.6%); 3) trouble adhering to discharge medications (5.7%); 4) difficulty accessing discharge medications (5.0%); and 5) lack of social support (4.7%). Low-socioeconomic status (SES) (defined as uninsured or Medicaid) patients were more likely than high-SES patients to report difficulty understanding (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.1, 6.6) and executing (OR 2.2; 95% CI 1.1, 4.4) discharge instructions, difficulty adhering to medications (OR 1.8; 95% CI 1.2, 3.0), lack of social support (OR 2.0; 95% CI 1.2, 3.6), lack of basic resources (OR 2.6; 95% CI 1.1, 6.1), and substance abuse (OR 6.7; 95% CI 2.3, 19.2). CONCLUSIONS Patients reported transition challenges which they believe contribute to illness relapse and readmission. Interventions designed to address these challenges, and tailored for patient characteristics such as SES, may better address the root causes of readmission.
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Affiliation(s)
- Shreya Kangovi
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
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Abstract
Aims and objectives. The aim of this literature review was to examine empirical research to date on hospital discharge and illuminate areas in need of further exploration. Background. Discharging older people from hospital has long been associated with difficulties and complications. With a steady increase in the ageing population in Ireland and their use of acute hospital services, the successful management of hospital discharge is now a central concern to health service management. Methods. Using a seven-step approach by Stolz et al. [Scandinavian Journal of Caring Sciences (2004) Vol. 18, 111-119] a keyword database search was conducted which revealed 44 studies that matched the author's inclusion criteria. Results. These studies uncover aspects of the discharge process that are in need of further research, and particularly suggest more rigour in the measurement of hospital discharge outcomes. Relevance to clinical practice. This review focuses on a very important clinical issue given the predicted increase in the use of acute services by older people and the known vulnerabilities of the interface between hospital and community settings.
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Affiliation(s)
- Alice Coffey
- College Lecturer, Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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12
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Coffey A, McCarthy GM. Older people’s perception of their readiness for discharge and postdischarge use of community support and services. Int J Older People Nurs 2012; 8:104-15. [DOI: 10.1111/j.1748-3743.2012.00316.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Wong EL, Yam CH, Cheung AW, Leung MC, Chan FW, Wong FY, Yeoh EK. Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals. BMC Health Serv Res 2011; 11:242. [PMID: 21955544 PMCID: PMC3190337 DOI: 10.1186/1472-6963-11-242] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 09/29/2011] [Indexed: 11/25/2022] Open
Abstract
Background Studies have shown that effective discharge planning is one of the key factors related to the quality of inpatient care and unnecessary hospital readmission. The perception and understanding of hospital discharge by health professionals is important in developing effective discharge planning. The aims of this present study were to explore the perceived quality of current hospital discharge from the perspective of health service providers and to identify barriers to effective discharge planning in Hong Kong. Methods Focus groups interviews were conducted with different healthcare professionals who were currently responsible for coordinating the discharge planning process in the public hospitals. The discussion covered three main areas: current practice on hospital discharge, barriers to effective hospital discharge, and suggested structures and process for an effective discharge planning system. Results Participants highlighted that there was no standardized hospital-wide discharge planning and policy-driven approach in public health sector in Hong Kong. Potential barriers included lack of standardized policy-driven discharge planning program, and lack of communication and coordination among different health service providers and patients in both acute and sub-acute care provisions which were identified as mainly systemic issues. Improving the quality of hospital discharge was suggested, including a multidisciplinary approach with clearly identified roles among healthcare professionals. Enhancement of health professionals' communication skills and knowledge of patient psychosocial needs were also suggested. Conclusions A systematic approach to develop the structure and key processes of the discharge planning system is critical in ensuring the quality of care and maximizing organization effectiveness. In this study, important views on barriers experienced in hospital discharge were provided. Suggestions for building a comprehensive, system-wide, and policy-driven discharge planning process with clearly identified staff roles were raised. Communication and coordination across various healthcare parties and provisions were also suggested to be a key focus.
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Affiliation(s)
- Eliza Ly Wong
- Division of Health Systems, Policy and Management, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
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Beck CE, Khambalia A, Parkin PC, Raina P, Macarthur C. Day of discharge and hospital readmission rates within 30 days in children: A population-based study. Paediatr Child Health 2011; 11:409-12. [PMID: 19030310 DOI: 10.1093/pch/11.7.409] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adults discharged from hospital on a Friday are more likely to be readmitted within 30 days than are adults discharged midweek. No study has examined readmission rates for children by day of discharge. OBJECTIVE To determine the risk of readmission within 30 days by day of discharge in the paediatric population. METHODS The Canadian Institute for Health Information provided data on children 29 days to 18 years of age who were discharged from hospitals in Ontario between January 1996 and December 2000. Two groups of children (those who were readmitted within 30 days and those who were not) were compared on demographic and clinical characteristics. Multivariable modelling was used to account for potential confounding variables: age, sex, length of hospital stay, number of diagnoses, in-hospital operative procedure, in-hospital complication and hospital admission in the previous six months. RESULTS A total of 506,035 hospitalizations (involving 334,959 children) occurred over the study period. Of these children, 3.4% were readmitted within 30 days of discharge. In total, 3.6% of children discharged on a Friday were readmitted within 30 days compared with 3.3% of children discharged on a Wednesday. After adjusting for patient and hospital factors, Friday discharge was not associated with readmission within 30 days (adjusted RR 1.07, 95% CI 0.99 to 1.15). More significant predictors of readmission included number of diagnoses, in-hospital complications and hospital admission in the six months previous to the index admission date. CONCLUSION Risk of readmission within 30 days is not significantly increased for children discharged on a Friday compared with children discharged midweek. Significant risk factors for hospital readmission are patient complexity and disease severity.
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Affiliation(s)
- Carolyn E Beck
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team, The Hospital for Sick Children and the University of Toronto, Toronto
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15
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Chaparro L. How a "Special Caring Bond" is Formed Between the Chronically ill Patient and the Family Caregiver. AQUICHAN 2011. [DOI: 10.5294/aqui.2011.11.1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
La formación de vínculos en el ser humano tiene su origen en las relaciones de cuidado existentes a lo largo de la vida. Existen teorías que aplican para las situaciones en que el ser humano se encuentra en riesgo o al límite como la situación de enfermedad crónica. Objetivo: describir la forma como se constituye el “vínculo especial” de cuidado entre la díada cuidador familiar-persona con enfermedad crónica. Método: corresponde a la conclusión central de una investigación cualitativa en la que se construyó una teoría sustantiva que describe el proceso por el cual se constituye el “vínculo especial” que surgió con un abordaje de teoría fundamentada. Hallazgos: una estructura teórica que muestra el patrón construido en las díadas frente al significado del cuidado en un diagrama representativo producto de una investigación doctoral. Conclusiones: el esquema construido muestra al inicio una separación entre las dos personas de la díada, y a medida que se comparte la experiencia y van haciéndose más cercanos los intereses, la díada alcanza mayor expansión de su conciencia en el cuidado. En el mismo sentido, la funcionalidad de la persona con enfermedad crónica disminuye y el nivel de habilidad de cuidado aumenta.
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16
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Cultural diversity between hospital and community nurses: implications for continuity of care. Int J Integr Care 2010; 10:e036. [PMID: 20422021 PMCID: PMC2858515 DOI: 10.5334/ijic.508] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/15/2009] [Accepted: 01/19/2010] [Indexed: 11/29/2022] Open
Abstract
Introduction Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. Challenges In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’. Discussion We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.
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Borthwick R, Newbronner L, Stuttard L. 'Out of Hospital': a scoping study of services for carers of people being discharged from hospital. HEALTH & SOCIAL CARE IN THE COMMUNITY 2009; 17:335-349. [PMID: 19175427 DOI: 10.1111/j.1365-2524.2008.00831.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Successive government policies have highlighted the need to inform and involve carers fully in the hospital discharge process. However, some research suggests that many carers feel insufficiently involved and unsupported in this process. This paper summarises a scoping review to identify what the UK literature tells us about the service provision for carers, and its effectiveness, around the time of hospital discharge of the care recipient, and also describes a mapping exercise of the work currently being done by Princess Royal Trust for Carers Centres in England to support carers around the time of hospital discharge. The restriction to UK literature was dictated by the nature of the project; a modest review carried out for a UK-based voluntary sector organization. Fifty-three documents were reviewed, of which 19 papers (representing 17 studies) were reporting on primary research. As only five of these studies actually involved an intervention, it appears there is very little research from the UK which evaluates specific interventions to support carers around the time of hospital discharge of the care recipient. While the mapping exercise showed that in some areas there are services and/or initiatives in place which have been designed to improve the process of discharge for carers, in many places there is still a gap between what policy and research suggest should happen and what actually happens to carers at this time. Even where services and initiatives to support carers through the discharge process exist, there is only limited evidence from research or evaluation to demonstrate their impact on the carer's experience. Further research, both quantitative and qualitative, is required to address these areas and enable commissioners, providers and carers' organizations to work together towards a service in which patients and carers alike receive the support and help they need at this significant time of transition.
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Popejoy LL. Adult Protective Services Use for Older Adults at the Time of Hospital Discharge. J Nurs Scholarsh 2008; 40:326-32. [DOI: 10.1111/j.1547-5069.2008.00246.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maloney LR, Weiss ME. Patients' Perceptions of Hospital Discharge Informational Content. Clin Nurs Res 2008; 17:200-19. [DOI: 10.1177/1054773808320406] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ensuring that patients' informational needs have been met prior to hospital discharge sets the stage for successful self-management of recovery at home. This secondary analysis study aims to identify differences in the amount of discharge teaching content needed and received by adult medical-surgical patients on the basis of their sociodemographic characteristics and hospitalization-related factors. The Quality of Discharge Teaching Scale (QDTS) is used to measure patients' perceptions of the amount of discharge-related informational content they needed and received. Eighty-nine percent of patients receive more informational content than they perceived they needed. Nonwhite patients report more content needed than White patients. Patients with prior hospitalizations and cardiac patients report greater amounts of content received. The QDTS content subscales provide a mechanism for assessing patient perceptions of discharge informational needs and discharge content received that can be used for clinical practice and quality monitoring.
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Affiliation(s)
- Lynn R. Maloney
- Marquette University College of Nursing, Milwaukee,
Wisconsin,
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20
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Ganzella M, Zago MMF. The hospital discharge as evaluated by patients and their caregivers: an integrative literature review. ACTA PAUL ENFERM 2008. [DOI: 10.1590/s0103-21002008000200019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To evaluate hospital discharge among patients and their caregivers. METHODS: A integrative literature review was performed in the database of Pubmed, CINAHL and Lilacs from 2000 and 2005, focusing on the adult patient discharge and elderly with clinical-surgical problems, published in the English or Portuguese language. RESULTS: The population was made up of 54 publications and the sample was made up of 23 papers, which were sorted into two theme categories: 13 focused on the effectiveness and 10 on the process inefficiency. CONCLUDING REMARKS: In the subjects standpoints, the effectiveness of the discharge planning stems to the provision of information related to the disease and its treatment, contents suitable to their socioeducational characteristics and needs, through individual educational strategies, visual and written, and suitable communication among professionals, patients, caregivers and services.
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21
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Huby G, Brook JH, Thompson A, Tierney A. Capturing the concealed: Interprofessional practice and older patients' participation in decision-making about discharge after acute hospitalization. J Interprof Care 2007; 21:55-67. [PMID: 17365374 DOI: 10.1080/13561820601035020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this paper is to investigate ways in which the dynamics of interprofessional work shaped older patients' "participation" in decision-making about discharge from acute hospital care in a medical directorate of a District General Hospital in Scotland. Twenty-two purposively selected older patients and their key professional hospital carers in three different ward environments participated in the study. An ethnographic approach was adopted, involving semi-structured interviews with patients and staff combined with rigorous observation of the practical context for staff and patient interactions during the discharge planning process over a 5-month period. Patients' and staff's understanding of "decision-making" and their priorities for discharge were different, but patients' perspectives fragmented and became invisible. Care routines, which centred around assessments and the decisions that flowed from these tended to exclude both staff and patients from active decision-making. Research and practice on patient involvement in discharge decision-making needs to focus on the organizational context, which shapes patients', unpaid carers' and staff's interactions and the dynamics by which some views are privileged and others excluded. Procedurally driven care routines and their impact on patients', carers' and staff's opportunity to actively engage in decision-making should be re-considered from an empowerment perspective.
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Affiliation(s)
- Guro Huby
- Centre for Integrated Healthcare Research, School of Health in Social Sciences, University of Edinburgh, UK.
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22
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Abstract
Primary lay carers are increasingly important in the care of patients with cancer, but their role can be complex and extended. Potential carers may feel anything from highly committed to not at all interested in caregiving, but powerful social norms pressure them to accept the role, and reluctance may be hidden to avoid censure. The purpose of this review was to gain insights into caregiving reluctance and its consequences. The findings were organized into 4 major dimensions: demographic, physical, psychological, and social. Three major outcomes were identified: deterioration in the carer-patient relationship, reduced quality of care, and institutionalization. Definitive answers to the review questions remain elusive. Choice seems to be a major indicator of caregiving reluctance, although reluctance may not remain static over the caregiving trajectory. Caregiving reluctance remains an underexplored topic, particularly in the context of cancer.
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Affiliation(s)
- Letitia Burridge
- School of Population Health, University of Queensland, Herston, Queensland, Australia.
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23
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Pieper B, Sieggreen M, Freeland B, Kulwicki P, Frattaroli M, Sidor D, Palleschi MT, Burns J, Bednarski D, Garretson B. Discharge Information Needs of Patients After Surgery. J Wound Ostomy Continence Nurs 2006; 33:281-9; quiz 290-1. [PMID: 16717518 DOI: 10.1097/00152192-200605000-00009] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients who have undergone surgical procedures often have self-care concerns in their preparation for discharge from the hospital. This article examines the research literature about information needs of postoperative patients prior to their discharge. The most common concerns were the incision/wound care, pain management, activity level, monitoring for complications, symptom management, elimination, and quality of life. Because of their clinical knowledge of the perioperative experience, wound, ostomy, and continence nurses and other advanced practice nurses have a critical role in the development of discharge-educational programs for postoperative patients and caregivers. Because unmet discharge needs can contribute to poor patient outcomes and readmission, it is critical that wound, ostomy, and continence nurses, advanced practice nurses, and clinical staff nurses accurately identify patients' informational needs and find ways to meet these needs especially with the aging population, new/advanced surgical procedures, vulnerability/poverty, and literacy level of patients.
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Affiliation(s)
- Barbara Pieper
- College of Nursing, Wayne State University, Detroit, MI 48202, USA.
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24
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Hellesø R, Lorensen M. Inter-organizational continuity of care and the electronic patient record: A concept development. Int J Nurs Stud 2005; 42:807-22. [PMID: 16019003 DOI: 10.1016/j.ijnurstu.2004.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2004] [Revised: 07/05/2004] [Accepted: 07/08/2004] [Indexed: 10/26/2022]
Abstract
There is an expectation that the use of electronic patient records will contribute to continuity of care across organizations for the growing number of elderly and chronically ill people who need continuing nursing care after an episode of hospitalization. This article aims to explore the concept of inter-organizational continuity of care and to address the contribution, expectations and promises associated with the advent of the electronic patient record. A content analysis of the literature concerning concept development provided a model which indicates that inter-organizational continuity is a multidimensional concept, comprising individual and organizational perspectives with qualitative and quantitative properties.
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Affiliation(s)
- Ragnhild Hellesø
- Faculty of Medicine, Institute of Nursing and Health Sciences, University of Oslo, P.O. Box 1153 Blindern, NO-0318 Oslo, Norway.
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25
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Hellesø R, Sorensen L, Lorensen M. Nurses' information management at patients' discharge from hospital to home care. Int J Integr Care 2005; 5:e12. [PMID: 16773162 PMCID: PMC1395517 DOI: 10.5334/ijic.133] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Revised: 06/08/2005] [Accepted: 06/29/2005] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this paper is to explore and compare hospital and home care nurses' assessment of their information management at patients' discharge from hospital to home care before and after the hospital implemented an electronic nursing discharge note. THEORY This paper draws on the concept of inter-organizational continuity of care, and specifically addresses the contribution of the implementation of an electronic patient record (EPR). METHODS The study has a prospective descriptive design. A questionnaire addressing the information that hospital and home care nurses exchange when patients need continuing care after hospitalization was developed and used. RESULTS Hospital and home care nurses differed in the way they assessed the structures and content of the information they exchanged, both before and after the EPR implementation. CONCLUSION AND DISCUSSION There is a need to take account of the different organizational contexts within which the two nursing groups work. The organizational context (hospital versus home care) has implications for the nurses' assessment of the information they exchange. In further development of EPR, it is therefore essential to clarify the context-related information needs of the various health care provider groups as part of the commitment to patient safety.
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Affiliation(s)
- Ragnhild Hellesø
- Faculty of Medicine, Institute of Nursing and Health Sciences, University of Oslo, P.O. Box 1153 Blindern, NO-0318 Oslo, Norway.
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26
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Hellesø R, Lorensen M, Sorensen L. Challenging the information gap – the patients transfer from hospital to home health care. Int J Med Inform 2004; 73:569-80. [PMID: 15246037 DOI: 10.1016/j.ijmedinf.2004.04.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED The purpose of this paper is to identify the information that nurses in hospitals exchange with nurses in home health care (HHC), and what nurses perceive to be the most significant information to exchange. METHOD Nurses have an obligation to support and ensure continuity of patient care and to prevent an information gap when patients are transferred from one organizational of health care delivery to another organizational level, for example, from hospital to home health care. In an ongoing prospective study, nurses' pre-electronic nursing discharge note and their assessment of the information it was necessary to exchange at the same time was audited and analyzed. The results show variation in the completeness and content of the nursing discharge note. Nurses' understanding of the scope and content of information to be transmitted varies widely according to the context and the organizational health care level they work within. The implementation of an electronic nursing discharge note creates the opportunity to identify the accurate information elements that must be documented and exchanged between the nurses to ensure patient safety and inter-organizational continuity of care.
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Affiliation(s)
- Ragnhild Hellesø
- Faculty of Medicine, Institute of Nursing and Health Sciences, University of Oslo, P.O. Box 1153, Blindern, Oslo NO-0318, Norway.
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27
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Wolff JL, Kasper JD. Informal caregiver characteristics and subsequent hospitalization outcomes among recipients of care. Aging Clin Exp Res 2004; 16:307-13. [PMID: 15575125 DOI: 10.1007/bf03324556] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS It is reasonable to surmise that informal caregivers might influence access and use of health services among disabled older adults, although this relationship has not been well studied. The objective of this research was to examine caregiver attributes with respect to recipients' hospitalization experiences. METHODS Generalized estimating equations were used to generate population-average logistic regression models for the risk of incurring inpatient hospitalization or being delayed in discharge from hospital. Data come from a sample of 420 women aged 65 or older receiving informal care, who participated in both the Women's Health and Aging Study and its accompanying Caregiving Survey. RESULTS Individuals whose primary caregivers were characterized by feelings of competence in their role were 40% more likely to experience an inpatient hospitalization (p<0.05) but 48% less likely to be delayed in discharge from the hospital (p<0.05). Measures related to caregiver overload and personal gain were not found to be related to the likelihood of either incurring an inpatient admission or being delayed in hospital discharge, although individuals whose primary caregivers were characterized by role captivity (a measure related to perceived burden) were more than twice as likely to be delayed in discharge from the hospital (p<0.05) without controlling for other characteristics (p<0.10 in the multivariate model). Individuals whose primary caregivers reported being involved with recipients' medical professionals were 50% more likely to incur an inpatient hospitalization (p<0.01). CONCLUSION These findings suggest that primary caregiver attributes have relevance to recipients' hospitalization experiences.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, and Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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28
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Pearson P, Procter S, Wilcockson J, Allgar V. The process of hospital discharge for medical patients: a model. J Adv Nurs 2004; 46:496-505. [PMID: 15139938 DOI: 10.1111/j.1365-2648.2004.03023.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Pauline Pearson
- Department of Primary Health Care, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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29
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Huby G, Stewart J, Tierney A, Rogers W. Planning older people's discharge from acute hospital care: linking risk management and patient participation in decision-making. HEALTH RISK & SOCIETY 2004. [DOI: 10.1080/1369857042000219797] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Winkelman WJ, Leonard KJ. Overcoming structural constraints to patient utilization of electronic medical records: a critical review and proposal for an evaluation framework. J Am Med Inform Assoc 2004; 11:151-61. [PMID: 14633932 PMCID: PMC353022 DOI: 10.1197/jamia.m1274] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2002] [Accepted: 11/04/2003] [Indexed: 11/10/2022] Open
Abstract
There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An evaluation framework is proposed for use when considering adaptation of existing EPR systems for online patient access. Exemplars of patient-accessible EPR systems from the literature are evaluated utilizing the framework. From this study, it appears that traditional information system research and development methods may not wholly capture many pertinent social issues that arise when expanding access of EPR systems to patients. Critically rooted methods such as action research can directly inform development strategies so that these systems may positively influence health outcomes.
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Affiliation(s)
- Warren J Winkelman
- Centre for Global eHealth Innovation, University Health Network, Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada M5G 2C4.
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