Classifying discharge scenarios to improve understanding and care

2020 ◽  
Author(s):  
Brent Hyslop
Keyword(s):  
Quality Improvement ◽  
Older People ◽  
Hospital Discharge ◽  
Clinical Education ◽  
Discharge Planning ◽  
Clinical Staff ◽  
Safety Concerns ◽  
Delayed Discharge ◽  
Premature Discharge

Abstract Hospital discharge planning is valuable in improving care and avoiding discharge delays. This is highly relevant to older people. Although usual discharge planning is now well understood and applicable to most patients, a range of different discharge scenarios exist that involve different considerations. These less common scenarios appear less well understood and can be challenging for clinical staff. To improve understanding and care, this Commentary suggests a basic classification of six discharge planning scenarios. These are: usual discharge planning, premature discharge, rehabilitation selection, safety concerns, reluctant discharge and delayed discharge. Clinical and system responses to each scenario are briefly discussed. This classification could potentially be useful in clinical education and quality improvement.

scholarly journals Hospital social work and discharge planning for older people: challenges of working in a clinical setting

2021 ◽  
pp. 1-18
Author(s):  
Deirdre Heenan
Keyword(s):  
Social Work ◽  
Older People ◽  
Social Workers ◽  
Hospital Discharge ◽  
Discharge Planning ◽  
Small Scale ◽  
Central Function ◽  
Hospital Social Workers ◽  
Hospital Social Work ◽  
Transfers Of Care

Abstract Across the world acute hospitals are under unprecedented pressures due to shrinking budgets and increasing demand, against this backdrop they are also experiencing record levels of activity in Accident & Emergency and delayed transfers of care. Reducing pressure on hospitals by avoiding unnecessary admissions and delayed discharges has risen up the global policy agenda. However, reviews of strategies and policies have rarely involved discussions about the role that hospital social workers play in achieving timely hospital discharge. Yet discharge planning has become a, if not the, central function of these professionals. This paper presents the results of a small-scale exploratory study of hospital social work in an acute hospital in Northern Ireland. The findings reveal that the work of hospital social workers is characterised by increased bureaucracy, an emphasis on targets and a decrease in the time afforded to forming relationships with older people. Hospital social workers highlight concerns that the emphasis on discharge planning and pressures associated with the austerity agenda limits their capacity to provide other more traditional roles such as advocacy and counselling. It is argued that hospital social work should not be narrowly defined as ‘simply’ co-ordinating discharge plans. The tension that arises between expediting hospital discharge and advocating for older people and their families is also discussed.

Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence

2009 ◽  
Vol 18 (18) ◽  
pp. 2539-2546 ◽  
Author(s):  
Michael Bauer ◽  
Les Fitzgerald ◽  
Emily Haesler ◽  
Mara Manfrin
Keyword(s):  
Older People ◽  
Hospital Discharge ◽  
Best Practice ◽  
Discharge Planning ◽  
Frail Older People

The Institute for Healthcare Improvement–NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols

2020 ◽  
Vol 33 (6) ◽  
pp. 812-821
Author(s):  
Scott L. Zuckerman ◽  
Clinton J. Devin ◽  
Vincent Rossi ◽  
Silky Chotai ◽  
E. Hunter Dyer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Discharge Planning ◽  
Lumbar Fusion ◽  
Nonparametric Tests ◽  
Learning System ◽  
Design Quality ◽  
Implementation Phase ◽  
Healthcare Improvement ◽  
The Impact

OBJECTIVENational databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module.METHODSThe NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention.RESULTSThe novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0–10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342).CONCLUSIONSThe NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.

An Analysis of Systems of Classifying Mild Cognitive Impairment in Older People

2002 ◽  
Vol 36 (1) ◽  
pp. 133-140 ◽  
Author(s):  
Alexander Collie ◽  
Paul Maruff
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Older People ◽  
Classification Systems ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Genetic Studies ◽  
The Past ◽  
Made In

Objective: Over the past two decades, a number of systems have been developed for the classification of cognitive and behavioural abnormalities in older people, in order that individuals at high risk of developing neurodegenerative disease, particularly Alzheimer's disease, may be identified well before the disease manifests clinically. This article critically examines the inclusion and exclusion criteria of a number of such classification systems, to determine the effect that variations in criterion may have on clinical, behavioural and neuroimaging outcomes reported from older people with mild cognitive impairment. Method: Qualitative review of the literature describing systems of classifying mild cognitive impairment, and outcomes from clinical, behavioural, neuroimaging and genetic studies of older people with mild cognitive impairment. Results: The exclusion and inclusion criteria for these classification systems vary markedly, as do the design of studies upon which the validity of these systems has been assessed. Minor changes to individual exclusion/inclusion criterion may result in substantial changes to estimates of the prevalence and clinical outcome of mild cognitive impairment, while inadequate experimental design may act to confound the interpretation of results. Conclusions: As a result of these factors, accurate and consistent estimates of the outcome of mild cognitive impairments in otherwise healthy older people are yet to be obtained. On the basis of this analysis of the literature, optimal criteria via which accurate classifications of mild cognitive impairment can be made in future are proposed.

scholarly journals Validating Performance of a Hospital Discharge Planning Decision Tool in Community Hospitals

2017 ◽  
Vol 22 (5) ◽  
pp. 204-213 ◽  
Author(s):  
Diane E. Holland ◽  
Cheryl Brandt ◽  
Paul V. Targonski ◽  
Kathryn H. Bowles
Keyword(s):  
Hospital Discharge ◽  
Discharge Planning ◽  
Decision Tool ◽  
Community Hospitals ◽  
Planning Decision
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