Reinforcing discharge education and planning

Hospital Discharge Process: Context-Sensitive Care

The transition from hospital to home after surgery is a vulnerable time for all cardiac surgical patients, particularly older adults. This postoperative phase presents multiple physical, physiological, emotional, and socioeconomic challenges, not only for patients but also for their families and informal caregivers, who often describe this period as stressful and overwhelming. Health-care professionals, particularly nurses, play an integral role in a patient's discharge process; the challenges can be ameliorated through timely discharge planning and effective discharge education. The context-sensitive solutions shared in this paper propose enhancing nurses' discharge practices to provide individualized care and to facilitate the hospital-to-home transition.

Experiences of discharge planning practices among Indonesian nurses: A qualitative study

Background

Discharge planning is vital to preventing hospital readmission, and nurses play a key role. The COVID-19 pandemic has posed challenges to hospital services that may persist or recur. Therefore, exploring nurses' experiences with discharge planning practices before and during this pandemic is crucial.

Objective

This study aimed to describe the experiences of discharge planning practices among nurses at an Indonesian tertiary hospital before and during the COVID-19 pandemic.

Methods

A qualitative descriptive study design was used. Telephone interviews were conducted to collect data among ten nurses from March 2019 and continued between December 2020 and August 2021. Content analysis was done for data analysis.

Results

Two main themes emerged: 1) Challenges in discharge planning practices and 2) Perceived discharge planning as a professional responsibility. Implementing the inpatient ward fusion policy as part of the hospital's pandemic response presented greater challenges to nurses in coordinating care and performing discharge planning. Fear of COVID-19 infection, social distancing measures, and using personal protective equipment also affected how nurses delivered discharge education during the pandemic. However, the nurses sensed a greater responsibility to ensure the maintenance of essential components of discharge planning procedures to guarantee the patient's capability to perform self-care at home.

Conclusion

Nurses viewed discharge planning practices as their responsibility and continued them during the pandemic despite facing various challenges. In addition to recognizing the significance of nurses' roles in discharge planning practices and overall patient care, it is crucial to anticipate and address the diverse working patterns and styles among healthcare professionals in unified wards, ensuring effective coordination.

The role of collaborative decision-making in discharge planning: Perspectives from patients, family members and health professionals

AIM

To explore discharge planning with a range of key stakeholders in subacute care, including consumers.

DESIGN

Qualitative descriptive study.

METHODS

Patients (n = 16), families (n = 16), clinicians (n = 17) and managers (n = 12) participated in semi-structured interviews or focus groups. Following transcription, data were analysed thematically.

RESULTS

The overarching facilitator of effective discharge planning was collaborative communication, leading to shared expectations by all stakeholders. Collaborative communication was underpinned by four key themes: patient- and family-centred decision-making, early goal setting, strong inter- and intra-disciplinary teamwork, and robust patient/family education.

CONCLUSION

Effective planning for discharge from subacute care is enabled by shared expectations and collaborative communication between key stakeholders.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Effective discharge planning processes are underpinned by effective inter- and intra-disciplinary teamwork. Healthcare networks should foster environments that promote effective communication between and within multidisciplinary team members as well as with patients and their families. Applying these principles to discharge planning may assist in reducing length of stays and rates of preventable readmissions post-discharge.

IMPACT

This study addressed a lack of knowledge about effective discharge planning in Australian subacute care. It found that collaborative communication between stakeholders was an overarching facilitator of effective discharge planning. This finding impacts subacute service design and professional education.

REPORTING METHOD

COREQ guidelines were followed in reporting this study.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution in the design, data analysis or preparation of the manuscript.

Effectiveness of Discharge Education With the Teach-Back Method on 30-Day Readmission: A Systematic Review

OBJECTIVES

Teach-back methods are reported to improve patient outcomes by encouraging patient understanding and participation and are increasingly being used in various clinical settings. This study attempts to identify the effectiveness of discharge education using the teach-back method on 30-day readmission.

METHODS

MEDLINE, CINAHL, Embase, The Cochrane Library, and Web of Science were used to search experimental studies. The search terms were "discharged patient," "teach-back," and "30-day readmission" published in English up until July 2017. Two trained reviewers performed a critical appraisal of retrieved studies using the Risk of Bias Assessment tool for Nonrandomized Studies. Data were analyzed using Cochrane Review Manager (Revman) software 5.2.

RESULTS

A total of five studies were analyzed (3 studies on heart failure, 1 study on total joint replacement, and 1 study on a coronary artery bypass graft). The main content of the teach-back education was to confirm and reinforce the patients' comprehension of health-related information. Among the five studies, three studies were included in the meta-analysis. The odds ratio of 30-day readmission for discharge education with the teach-back method and usual care was 0.55 (95% confidence interval, 0.34-0.91; P = 0.02). The I2 score was 0%, which means that the analyzed studies are homogeneous.

CONCLUSIONS

The results indicate that discharge education with the teach-back method resulted in a 45% reduction in 30-day readmission. However, only a few studies were included in the analysis, and they showed a high risk of selection bias. Therefore, we suggest that well-designed randomized controlled trials be conducted.

Improving Patient Discharge Education Through Daily Educational Bursts: A Pilot Study

The purpose of this study was to investigate the impact that daily discharge education "bursts" using the teach-back method had on participants' confidence levels in their self-care management abilities. Daily educational bursts positively impacted participants' self-confidence in their postdischarge self-care management abilities. Nursing professional development practitioners could use the results of this study to address the inconsistency of providing effective, daily discharge education for patients.

GP perspectives on hospital discharge letters: an interview and focus group study

BACKGROUND

Written discharge communication following inpatient or outpatient clinic discharge is essential for communicating information to the GP, but GPs' opinions on discharge communication are seldom sought. Patients are sometimes copied into this communication, but the reasons for this variation, and the resultant effects, remain unclear.

AIM

To explore GP perspectives on how discharge letters can be improved in order to enhance patient outcomes.

DESIGN & SETTING

The study used narrative interviews with 26 GPs from 13 GP practices within the West Midlands, England.

METHOD

Interviews were transcribed and data were analysed using corpus linguistics (CL) techniques.

RESULTS

Elements pivotal to a successful letter were: diagnosis, appropriate follow-up plan, medication changes and reasons, clinical summary, investigations and/or procedures and outcomes, and what information has been given to the patient. GPs supported patients receiving discharge letters and expounded a number of benefits of this practice; for example, increased patient autonomy. Nevertheless, GPs felt that if patients are to receive direct discharge letter copies, modifications such as use of lay language and avoidance of acronyms may be required to increase patient understanding.

CONCLUSION

GPs reported that discharge letters frequently lacked content items they assessed to be important; GPs highlighted that this can have subsequent ramifications on resources and patient experiences. Templates should be devised that put discharge letter elements assessed to be important by GPs to the forefront. Future research needs to consider other perspectives on letter content, particularly those of patients.

Nurses' role in delivering discharge education to general surgical patients: A qualitative study

AIMS

To explore nurses' perceived role and experience in providing discharge education to general surgical patients.

DESIGN

Qualitative, using focus groups and face-to-face individual interviews.

METHODS

Purposive sampling with maximum variation was used to recruit nurses from the general surgical wards in a tertiary hospital in Queensland, Australia. Semi-structured interviews (three focus groups and four individual interviews) were conducted with 21 nurses involved in delivering postoperative discharge education from August 2018 - July 2019. Interview data were analysed using inductive content analysis.

RESULTS

Four themes emerged: assuming responsibility for patient education in the absence of discharge communication; supporting patients to participate in self-management after hospitalization; variability in the resources, content and delivery of discharge education; and meeting operational demands compromises the quality of patients' discharge education.

CONCLUSION

This study highlights the importance of nurses' role and the challenges encountered in delivering effective discharge education. These findings can be used to identify strategies to enhance discharge communication among health professionals and standardize the delivery of education to improve surgical patients' postoperative outcomes.

IMPACT

Ineffective discharge education contributes to patients' poor management of their postdischarge recovery. Developing an understanding of nurses' role in discharge education can inform policies and nursing practice to improve patients' well-being and reduce the potential for unplanned and emergency care.

Improving best practice for patients receiving hospital discharge letters: a realist review

OBJECTIVE

To understand how different outcomes are achieved from adult patients receiving hospital discharge letters from inpatient and outpatient settings.

DESIGN

Realist review conducted in six main steps: (1) development of initial theory, (2) searching, (3) screening and selection, (4) data extraction and analysis, (5) data synthesis and (6) programme theory (PT) refinement.

ELIGIBILITY CRITERIA

Documents reporting evidence that met criteria for relevance to the PT. Documents relating solely to mental health or children aged <18 years were excluded.

ANALYSIS

Data were extracted and analysed using a realist logic of analysis. Texts were coded for concepts relating to context, mechanism, outcome configurations (CMOCs) for the intervention of patients receiving discharge letters. All outcomes were considered. Based on evidence and our judgement, CMOCs were labelled 'positive' or 'negative' in order to clearly distinguish between contexts where the intervention does and does not work.

RESULTS

3113 documents were screened and 103 were included. Stakeholders contributed to refining the PT in step 6. The final PT included 48 CMOCs for how outcomes are affected by patients receiving discharge letters. 'Patient choice' emerged as a key influencer to the success (or not) of the intervention. Important contexts were identified for both 'positive' CMOCs (eg, no new information in letter) and 'negative' CMOCs (eg, letter sent without verifying patient contact details). Two key findings were that patient understanding is possibly greater than clinicians perceive, and that patients tend to express strong preference for receiving letters. Clinician concerns emerged as a barrier to wider sharing of discharge letters with patients, which may need to be addressed through organisational policies and direction.

CONCLUSIONS

This review forms a starting point for explaining outcomes associated with whether or not patients receive discharge letters. It suggests several ways in which current processes might be modified to support improved practice and patient experience.