A cross-sectional study of readiness for discharge, chronic illness resources and postdischarge outcomes in patients with diabetic foot ulcer

Are patients ready for discharge from the hospital after fast-track total knee arthroplasty?-A qualitative study

BACKGROUND

The fast-track based on evidence-based medicine, has dramatically reduced the length of stay for patients undergoing total knee arthroplasty (TKA). Therefore, patients must assume the responsibility for self-functional exercise and care as early as possible. Also, higher standards and expectations of care delivery have been set. Studies into patients' experiences when faced with a discharge decision under a fast-track program are lacking.

OBJECTIVES

(1) Increase the knowledge about patients' experiences of discharged from hospital via a fast-track process after TKA. (2) Explore what gaps exist in the current discharge preparation care service for TKA under fast-track and what can be improved.

METHODS

A qualitative research design was chosen to conduct semi-structured face-to-face interviews with 21 patients from one Chinese hospital who successfully underwent TKA and received discharge orders. Interview data were meticulously analyzed, summarized and thematically distilled using Interpretative Phenomenological Analysis (IPA).

RESULTS

Three themes emerged from the structural analyses: a) Preparing for discharge despite concerns about symptoms-a sense of joy at discharge despite feelings of helplessness, stigmatisation, anxiety about prosthetic function. b) Managing the rehabilitation difficulties-vigilance is needed for medication management, environmental changes, and intimate relationships. c) Creating conditions for safe transition-compassionate bedside manner, listening to patients, and providing a humanized continuing care and referral services are important for safe transitions.

CONCLUSION

Findings suggest that patients undergoing fast-track TKA report good discharge preparation experiences. However, closer analysis reveals difficulties with this process and important directions in which discharge readiness care services can strive.

Theoretical concepts and instruments for measuring hospital discharge readiness: A scoping review

Background

The Discharge Readiness of adult patients in a hospital setting is a multidimensional concept which is becoming increasingly important internationally as part of discharge planning. To date, there has been a lack of reviews of existing measurement instruments as well as theoretical concepts of discharge readiness.

Objective

To provide an overview of existing measurement instruments and theoretical concepts regarding readiness for hospital discharge in adult patients.

Design and methods

A scoping review was conducted in accordance with the Joanna Briggs Institute methodological manual and PRISMA ScR reporting principles. A literature search was conducted using the CINAHL and LIVIVO databases (including MEDLINE and PSYINDEX) in October 2021. After test screening, all identified articles were screened by two independent reviewers using predefined inclusion and exclusion criteria before the content was extracted and mapped.

Results

Of the 1823 records identified, 107 were included in this review. Of these, 30 studies were included as development or validation studies of measurement instruments assessing discharge readiness, 68 were included as empirical studies with readiness for hospital discharge as the primary outcome or key concept, and nine publications were included as theoretical papers or reviews. Five dimensions of readiness for hospital discharge were extracted:1) Physical, 2) Psychological, 3) Education and Knowledge, 4) Adequate Individual Support, and 5) Social and Organisational Determinants. Of the 47 instruments identified for measuring discharge readiness, 33 were validated. The Readiness for Hospital Discharge Scale (RHDS) was the most frequently used instrument.

Conclusions

The systematic measurement of readiness for hospital discharge, particularly from the patient's perspective combined with the nurse's perspective, might be useful in reducing negative outcomes such as readmissions. This review provides an overview of existing and validated instruments for the systematic assessment of discharge readiness in acute inpatient care, as well as an overview of the theoretical concepts of readiness for hospital discharge. Further research is needed on the relationship between organisational determinants and readiness for discharge.

A cross-sectional study of readiness for discharge, chronic illness resources and postdischarge outcomes in patients with diabetic foot ulcer

Aim

To investigate the correlation of readiness for hospital discharge, the chronic illness resources, and postdischarge outcomes of diabetic foot ulcer patients, which can be help for discharged patient rehabilitation.

Design

A cross‐sectional study.

Methods

One hundred and seventy‐nine patients were recruited from the Endocrinology units of two tertiary hospitals between November 2018–September 2019, in Guangdong, China. The methods used were Readiness for Hospital Discharge Scale, The Chronic Illness Resources Survey and one‐on‐one telephone interviews.

Results

Pearson correlation coefficients indicated moderate correlation between the readiness for discharge and resource availability for chronic illnesses (r = .446, p < .001). Multiple linear regression analysis showed that Chronic Illness Resources Survey, self‐care ability, methods of wound treatments after discharge, and living alone were the main predictors of readiness for hospital discharge among diabetic foot ulcer patients (F = 12.272, p < .001, R² = .621, Rad2 = .571). The study was limited by location, patient's recall bias and lack of BADL scale, which can be further improved in subsequent studies by developing multi‐centre clinical study and adopting more objective assessment tools.