scholarly journals Goals of Care or Goals of Life? A qualitative study of clinicians’ and patients’ experiences of hospital discharge using Patient-Oriented Discharge Summaries (PODS)

2020 ◽  
Author(s):  
Nayantara Hattangadi ◽  
Paul Kurdyak ◽  
Rachel Solomon ◽  
Sophie Soklaridis
Keyword(s):  
Hospital Discharge ◽  
Planning Process ◽  
Discharge Planning ◽  
Discrete Event ◽  
Discharge Summary ◽  
Qualitative Inquiry ◽  
Structured Interviews ◽  
Post Discharge ◽  
Goals Of Care ◽  
Asymmetrical Information

Abstract Background : Recognizing the need for improved communication with patients at the point of hospital discharge, a group of clinicians, patients, and designers in Toronto, Canada collaborated to develop a standardized tool known as the Patient-Oriented Discharge Summary (PODS). Although quantitative results suggest PODS helps mitigate gaps in knowledge, a qualitative inquiry from the clinician and patient perspective of hospital discharge using PODS has not been widely explored. Methods : We used a qualitative research design to explore clinicians’ and patients’ experiences with PODS. We used convenience sampling to identify and invite potential participants at the Center for Addiction and Mental Health in Toronto, Canada to participate in semi-structured interviews. Data was analyzed using a thematic analysis approach to develop descriptive themes. Results : The themes that emerged based on PODS experience was influenced by the asymmetrical information advantaged that clinicians had with the discharge planning process. Thus, the themes from the data between clinicians and patients were both different and complementary. Clinicians described PODS using the concept of “goals of care.” They relayed their experiences with PODS as a discrete event and emphasized its role in meeting their “goals of care” for discharge planning. Patients provided more of a “goals of life” perspective on recovery. They characterized PODS as only one facet of their recovery journey and not necessarily as a discrete or memorable event. Patients focused on their outcomes post-discharge and situated their experiences with PODS through its relation to their overall recovery. Conclusions : PODS was experienced differently by clinicians and patients. Clinicians experienced PODS as helpful in orienting them to the fulfillment of goals of care. Patients did not experience PODS as a particularly memorable intervention. Due to the asymmetrical information advantage that clinicians have about PODS, it is not surprising that clinicians and patients experienced the PODS differently. Despite that an asymmetrical relationship exists between clinician and patients, it did not detract from the potential benefits of PODS for the patient. This study expanded our understanding of hospital discharge from clinicians and patients perspectives, and suggests that there are additional areas that need improvement.

scholarly journals Goals of Care or Goals of Life? A qualitative study of clinicians’ and patients’ experiences of hospital discharge using Patient-Oriented Discharge Summaries (PODS)

2020 ◽  
Author(s):  
Nayantara Hattangadi ◽  
Paul Kurdyak ◽  
Rachel Solomon ◽  
Sophie Soklaridis
Keyword(s):  
Hospital Discharge ◽  
Thematic Analysis ◽  
Discharge Planning ◽  
Discrete Event ◽  
Discharge Summary ◽  
Qualitative Inquiry ◽  
Structured Interviews ◽  
Post Discharge ◽  
Goals Of Care ◽  
Information Advantage

Abstract Background: Recognizing the need for improved communication with patients at the point of hospital discharge, a group of clinicians, patients, and designers in Toronto, Canada collaborated to develop a standardized tool known as the Patient-Oriented Discharge Summary (PODS). Although quantitative results suggest PODS helps mitigate gaps in knowledge, a qualitative inquiry from the clinician and patient perspective of psychiatric hospital discharge using PODS has not been widely explored. Our aim was to explore clinicians’ and patients’ experiences with PODS.Methods: We used a qualitative thematic analysis to explore clinicians’ (n=10) and patients’ (n=6) experiences with PODS. We used convenience sampling to identify and invite potential participants at the Center for Addiction and Mental Health in Toronto, Canada to participate in semi-structured interviews between February 2019 and September 2019. Data was analyzed using a thematic analysis approach to develop descriptive themes. Results: Emerging themes from the data between clinicians and patients were both different and complementary. Clinicians described PODS using the concept of “goals of care.” They relayed their experiences with PODS as a discrete event and emphasized its role in meeting their “goals of care” for discharge planning. Patients provided more of a “goals of life” perspective on recovery. They characterized PODS as only one facet of their recovery journey and not necessarily as a discrete or memorable event. Patients focused on their outcomes post-discharge and situated their experiences with PODS through its relation to their overall recovery.Conclusions: PODS was experienced differently by clinicians and patients. Clinicians experienced PODS as helpful in orienting them to the fulfillment of goals of care. Patients did not experience PODS as a particularly memorable intervention. Due to the information advantage that clinicians have about PODS, it is not surprising that clinicians and patients experienced the PODS differently. This study expanded our understanding of hospital discharge from clinicians and patients perspectives, and suggests that there are additional areas that need improvement.

scholarly journals The Relationship between Staff Compliance with Implementing Discharge Planning Guidelines, and Stroke Patients’ Experiences Post-Discharge

2009 ◽  
Author(s):  
Julie Luker ◽  
Karen Grimmer-Somers
Keyword(s):  
Acute Stroke ◽  
Hospital Discharge ◽  
Clinical Guideline ◽  
Discharge Planning ◽  
Community Support ◽  
Hospital Staff ◽  
Structured Interviews ◽  
Stroke Patients ◽  
Post Discharge ◽  
Planning Methods

Purpose: To investigate staff compliance with discharge planning clinical guideline recommendations in an acute stroke unit, and its relationship with post-discharge experiences of stroke patients and their carers. Subjects: Fifty acute stroke patients were systematically recruited for a retrospective patient record audit of staff compliance with clinical guideline recommendations related to discharge planning. Methods: Semi-structured interviews were conducted over six months post-discharge on patients’ actual community support needs and experiences. Audit and patient experience data were integrated to seek evidence of 1) characteristics of patients receiving guideline-compliant care, 2) relationships between staff compliance with discharge planning recommendations and patient’s post-discharge experiences, and 3) whether patient’s post-discharge experiences of shortfalls in support related to hospital discharge planning. Results: Not all patients received guideline-based care. There was a trend that patients with more complex strokes received guideline-compliant care than other patients. Compliance with providing an occupational therapy (OT) home assessment was significantly related to discharge directly home from hospital. There was a shortfall with 40% of patients between community supports predicted by hospital staff and actual post-discharge support requirements. Community support requirements increased over time for 32% of patients, whose six-month post-discharge needs were actually greater than their needs at six weeks. Conclusions: Staff compliance with discharge planning recommendations was variable and did not always relate to improved post-discharge patient experiences. The post-discharge experiences of many stroke patients could not have been predicted whilst they were in hospital. Discharge planning and support systems thus need to be flexible and responsive to short and long-term needs.

Is there a shift in use of subacute rehabilitation (SAR) instead of hospice referral since immunotherapy became available?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11530-11530
Author(s):  
Jonathan Yeh ◽  
Louise Knight ◽  
Joyce M. Kane ◽  
Danielle Doberman ◽  
Arjun Gupta ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Discharge Planning ◽  
Drug Approval ◽  
Do Not Resuscitate ◽  
Post Discharge ◽  
Goals Of Care ◽  
Code Status ◽  
Hospice Referral ◽  
Electronic Chart ◽  
Time Of Admission

11530 Background: Immunotherapy has rapidly become mainstream treatment. Since the first drug approval in 2011, we have noted a decline in referrals from inpatient oncology to hospice, and an increase in referrals to sub-acute rehabilitation (SAR) facilities, possibly with the aim of “getting strong enough” for immunotherapy and other promising drugs. This study explores outcomes after discharge to SAR, including rates of cancer-directed therapy after SAR, overall survival, and hospice utilization. Methods: Electronic chart review of patients discharged from oncology units to SAR facilities from 2009-2017. Demographics, admission statistics, and post-discharge outcomes were gathered from discharge summaries and targeted chart searches. Results: SAR referrals increased from 28 in 2012 to 82 in 2016. Age 66, males 52%, solid tumors 58%. 358 patients were referred to SAR 413 times. 174 patients (49%) returned to the oncology clinic prior to re-admission or death, and only 117 (33%) ever received further cancer-directed treatment (chemotherapy, radiation, or immunotherapy). 219 of 358 (61%) died within 6 months. Only 3 individuals who were not on immunotherapy at time of admission went on to receive immunotherapy after discharge to SAR. Among all discharges, 28% led to readmissions within 30 days. 74 patients (21%) were deceased within 30 days, of whom only 31% were referred to hospice. Palliative care involvement resulted in more frequent do not resuscitate (DNR) code status (33 v 22%), documented goals of care (GOC) discussions (81 v 23%), and electronic advance directives (42 v 28%).(All p<0.05). Conclusions: A growing number of oncology inpatients are being discharged to SAR, but two-thirds do not receive further cancer therapy at any point, including a substantial fraction that are re-admitted or deceased within 1 month. Many patients lose the opportunity to use hospice for optimal end of life care, as few SAR facilities offer this. These data can help guide decision-making and discharge planning that aligns with patients’ goals of care. More clinical data are needed to predict who is most likely to benefit from SAR and proceed to further cancer therapy.

scholarly journals Development of a single, practical measure of surgical site infection (SSI) for patient report or observer completion

2017 ◽  
Vol 18 (4) ◽  
pp. 170-179 ◽  
Author(s):  
Rhiannon C Macefield ◽  
Barnaby C Reeves ◽  
Thomas K Milne ◽  
Alexandra Nicholson ◽  
Natalie S Blencowe ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Phase 1 ◽  
Surgical Site Infections ◽  
Structured Interviews ◽  
Post Discharge ◽  
Single Measure ◽  
Patient Morbidity ◽  
Reliable Assessment ◽  
Three Phase ◽  
Measurement Tools

Background: Surgical site infections (SSIs) are the third most common hospital-associated infection and can lead to significant patient morbidity and healthcare costs. Identification of SSIs is key to surveillance and research but reliable assessment is challenging, particularly after hospital discharge when most SSIs present. Existing SSI measurement tools have limitations and their suitability for post-discharge surveillance is uncertain. Aims: This study aimed to develop a single measure to identify SSI after hospital discharge, suitable for patient or observer completion. Methods: A three-phase mixed methods study was undertaken: Phase 1, an analysis of existing tools and semi-structured interviews with patients and professionals to establish the content of the measure; Phase 2, development of questionnaire items suitable for patients and professionals; Phase 3, pre-testing the single measure to assess acceptability and understanding to both stakeholder groups. Interviews and pre-testing took place over 12 months in 2014–2015 with patients and professionals from five specialties recruited from two UK hospital Trusts. Findings: Analyses of existing tools and interviews identified 19 important domains for assessing SSIs. Domains were developed into provisional questionnaire items. Pre-testing and iterative revision resulted in a final version with 16 items that were understood and easily completed by patients and observers (healthcare professionals). Conclusion: A single patient and observer measure for post-discharge SSI assessment has been developed. Further testing of the validity, reliability and accuracy of the measure is underway.

scholarly journals Caregivers’ Perspectives of Medication Management Advice for People With Dementia at Hospital Discharge

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 206-206
Author(s):  
Mouna Sawan ◽  
Yun-Hee Jeon ◽  
Christine Bond ◽  
Timothy Chen ◽  
Sarah Hilmer ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Medication Management ◽  
Discharge Summary ◽  
Transitions Of Care ◽  
Care Recipient ◽  
Structured Interviews ◽  
Caregiver Education ◽  
People With Dementia ◽  
Management Advice ◽  
Competing Priorities

Abstract People with dementia admitted to hospitals are more likely to be exposed to inappropriate polypharmacy and experience worse outcomes than people without dementia. Family and informal caregivers play an important role in managing medications across transitions of care; however, studies describing the experiences of medication guidance provided to caregivers at hospital discharge are limited. We have explored caregivers’ perceptions on the quality of and factors that influence caregiver participation in medication guidance at discharge. A qualitative approach using semi-structured interviews was conducted with 29 caregivers of people with dementia across Australia by telephone. Purposive sampling was used to ensure maximum variation of diverse perspectives. Content analysis was used to derive themes. Three themes were derived from analysis: inconsistent approaches to provision of medication information at discharge, caregiver awareness to advocate for the care recipient and managing competing priorities. Some caregivers reported inadequate information was provided because the information was communicated to the patient without the caregiver being present. Other caregivers stated a medication list, discharge summary and discussion with a healthcare profession provided useful information. Caregiver involvement in discussions on medication guidance at discharge was influenced by caregiver awareness to advocate for the care recipient to ensure medication safety and managing competing priorities at the time of discharge to manage stress. Caregivers flagged the need to establish structured caregiver education at discharge and community-based services to manage medications safely. Future studies are needed to explore development of resources to caregiver encourage participation during medication guidance at discharge.

scholarly journals Reasons for Returning to the Emergency Department: Perspectives of Patients and the Liaison Nurse Clinician

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Molywan Vat ◽  
Carol Common ◽  
Andrea Laizner ◽  
Christine Maheu
Keyword(s):  
Internal Medicine ◽  
Emergency Department ◽  
Health Care Professionals ◽  
Discharge Planning ◽  
Evaluation Tools ◽  
Structured Interviews ◽  
Post Discharge ◽  
Convenience Sample ◽  
Nurse Clinician ◽  
Liaison Nurse

Objectives: The authors wanted to understand the reasons why patients discharged from internal medicine units return to the emergency department within a short term period. The purpose of the study was to explore patients’ perspective of their reasons for returning to the emergency department within fourteen days post-discharge from an internal medicine unit, and to examine how these reasons relate to those determined by the liaison nurse clinician prior to discharge.Methods: A qualitative descriptive design was selected to develop the study and individual face-to-face semi-structured interviews were conducted with participants. A convenience sample of eight participants was recruited from a major teaching hospital in Montreal, Canada. The study triangulated three different data sources, which were the patient’s perspective through the interview and the liaison nurse clinician’s perspective through the use of two evaluation tools, which were the Bounceback Probability Legend and the LACE Index Scoring Tool.Results: The participants attributed their return to the emergency department due to 1) being discharged too soon, 2) feeling weak at discharge, 3) having limited discharge instructions prior to discharge, and 4) having limited resources available to rely on for help once home. It was also noticed that participants went through a decision-making process for choosing to return to the emergency department. Additionally, the liaison nurse clinician’s evaluation tools identified different reasons from those the participants had attributed to their return to the emergency department.Conclusions: The findings suggest that health care professionals must evaluate and assess patients on several components upon their discharge, such as the understanding of their illness, primary concerns, and readiness prior to discharge. The study provides further data in supporting the need of patient’s involvement in the process of discharge planning.

Hospital discharge: recommendations for performance improvement for family carers of people with dementia

2011 ◽  
Vol 35 (3) ◽  
pp. 364 ◽  
Author(s):  
Leslie R. Fitzgerald ◽  
Michael Bauer ◽  
Susan H. Koch ◽  
Susan J. King
Keyword(s):  
Hospital Discharge ◽  
Health Professionals ◽  
Policy Process ◽  
Best Practice ◽  
Discharge Planning ◽  
Family Carer ◽  
Family Carers ◽  
Post Discharge ◽  
People With Dementia ◽  
The Family

Background. It is acknowledge that discharge planning benefits both consumers and hospitals. What is not widely understood is the experience that the family carer of a person with a dementia has and whether the hospitals meet their in-hospital and post-hospital needs. Objective. To explore whether metropolitan and rural hospital discharge practices meet the needs of the family carer of a person with dementia. Results. Although this and other research indicates that a continuum of care model is beneficial to family caregivers, no evidence has been identified that family carers currently experience this type of quality planning. Family carers were often unaware of the existence of a hospital discharge plan and were rarely engaged in communication about the care of their family member with a dementia or prepared for discharge. Conclusion and recommendations. Discharge planning processes for family carers of people with dementia could be substantially improved. It is recommended that hospitals develop policy, process and procedures that take into account the family carer’s needs, develop key performance indicators and adopt best practice standards that direct discharge planning activities and early engagement of the family carer in healthcare decisions. It is recommended that health professionals be educated on communication, consultation and needs of family carers. What is known about the topic? The literature shows discharge planning can increase in patient and caregiver satisfaction, reduce post-discharge anxiety, reduce unplanned readmissions and reduce post-discharge complications and mortality. To be effective, discharge planning requires interdisciplinary collaboration; yet for people with a dementia there are insufficient system processes to support discharge planning, routine breakdowns in communication between patient, family caregivers and health professionals and inadequate admission and aftercare plans. There is little known about the discharge planning as it effects the family carer’s of people with dementia. What does this paper add? This research provides evidence of the family carer’s experience of metropolitan and rural hospital discharge as it relates to planning, preparation and support. It investigates how well the discharge planning process met the needs of the family carer and what improvements are required if hospital discharge planning is to be more effective. The research identifies a range of initiatives that hospital and health professionals can implement to improve current discharge practices for family carers of people with dementia. What are the implications for practitioners? This report makes recommendations for changes to hospital health systems and the discharge practices of health professionals. Hospitals need to develop policy, process and procedure that take into account family carer’s needs, develop key performance indicators that measure discharge planning practices, and adopt best practice activities that include such items as early engagement of the primary carer’s, the identification of a liaison health professional and implementation of a policy that requires family carers to be involved in and notified of an impending discharge. It is recommended that health professionals be educated on the needs of family carers as it relates to communication and consultation. The primary carer is involved in discussions and decisions about in-hospital and post-hospital treatment regimes and is in agreement with, and competent in, post-discharge treatments, therapies and support services.

scholarly journals Has There Been a Shift in Use of Subacute Rehabilitation Instead of Hospice Referral Since Immunotherapy Has Become Available?

2019 ◽  
Vol 15 (10) ◽  
pp. e849-e855
Author(s):  
Jonathan C. Yeh ◽  
Louise S. Knight ◽  
Joyce Kane ◽  
Danielle J. Doberman ◽  
Arjun Gupta ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Discharge Planning ◽  
Drug Approval ◽  
Do Not Resuscitate ◽  
Multiple Cancer ◽  
Post Discharge ◽  
Goals Of Care ◽  
Code Status ◽  
Hospice Referral ◽  
Hospice Use

PURPOSE: Immunotherapy has rapidly become the mainstream treatment of multiple cancer types. Since the first drug approval in 2011, we have noted a decline in referrals from inpatient oncology to hospice and an increase in referrals to subacute rehabilitation (SAR) facilities, possibly with the aim of getting strong enough for immunotherapy and other promising drugs. This study explores outcomes after discharge to SAR, including rates of cancer-directed therapy after SAR, overall survival, and hospice use. METHODS: We performed an electronic chart review of patients discharged from our inpatient oncology units to SAR facilities from 2009 to 2017. Demographics, admission statistics, and post-discharge outcomes were gathered from discharge summaries and targeted chart searches. RESULTS: Three hundred fifty-eight patients were referred to SAR 413 times. One hundred seventy-four patients (49%) returned to the oncology clinic before readmission or death, and only 117 (33%) ever received additional cancer-directed treatment (chemotherapy, radiation, or immunotherapy). Among all discharges, 28% led to readmissions within 30 days. Seventy-four patients (21%) were deceased within 30 days, only 31% of whom were referred to hospice. Palliative care involvement resulted in more frequent do not resuscitate code status, documented goals of care discussions, and electronic advance directives. CONCLUSION: A growing number of oncology inpatients are being discharged to SAR, but two thirds do not receive additional cancer therapy at any point, including a substantial fraction who are readmitted or deceased within 1 month. These data can help guide decision making and hospital discharge planning that aligns with patients’ goals of care. More clinical data are needed to predict who is most likely to benefit from SAR and proceed to further cancer therapy.

Abstract 56: Prognosis of Patients with Acute Myocardial Infarction by Hospital Discharge Diagnosis

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Emily B Levitan ◽  
Olusola T Olubowale ◽  
Christopher Gamboa ◽  
Todd M Brown ◽  
Paul Muntner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Discharge ◽  
Racial Differences ◽  
Cardiovascular Mortality ◽  
Discharge Summary ◽  
Discharge Diagnosis ◽  
Post Discharge ◽  
All Cause Mortality ◽  
Regards Study

Background: Research on acute myocardial infarction (AMI) in medical claims largely focuses on hospitalizations where AMI is the primary discharge diagnosis (dx). Limited data are available on AMIs occurring as a secondary dx during hospitalization. Hypothesis: We hypothesized that mortality following AMI is higher when the primary dx is not AMI. Methods: We examined REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants with definite or probable AMIs adjudicated using published guidelines. Participants were categorized by hospital discharge dx from the discharge summary: primary dx, secondary dx, or no dx of AMI. All-cause and cardiovascular mortality after AMI, detected though active follow-up and the National Death Index, were compared using Kaplan-Meier curves with log-rank tests and Cox proportional hazard models adjusted for sociodemographics, medical history, and characteristics of the AMI (clinical evidence of ischemia, peak troponin, and heart failure during hospitalization). Results: Of 877 participants with AMI, 37% had AMI as primary dx, 12% had AMI as a secondary dx, and 51% had no dx of AMI. All-cause mortality (n = 284) was higher among participants with AMI as a secondary dx or without a dx of AMI than among participants with AMI as primary dx, but cardiovascular mortality (n = 150) was similar across groups ( Figure ). Compared to participants with AMI as primary dx, adjusted hazard ratios for all-cause mortality were 1.03 (95% CI 0.68-1.57) and 1.17 (95% CI 0.84-1.62) and for cardiovascular mortality were 0.79 (95% CI 0.46-1.37) and 0.91 (95% CI 0.60-1.38) for participants with AMI as a secondary dx and without a dx of AMI, respectively. Conclusions: Studies of AMI based on primary discharge dx likely under count the number of AMIs and exclude a population with similar prognosis in terms of all-cause and CVD mortality, once clinical differences considered. Further study into the characteristics, in-hospital and post-discharge management of these patients may be warranted.

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