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Rossi S, Hayter M, Zuco A, Tappino F, Tirone R, Scelsi S. Essential elements nurses have to address to promote a safe discharge in paediatrics: A systematic review and narrative synthesis. Nurs Open 2024; 11:e2043. [PMID: 38268292 PMCID: PMC10697128 DOI: 10.1002/nop2.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM The aim of the study was to synthesize the evidence on the essential elements, nurses must address when they perform therapeutic education to patients and their caregivers to promote a safe paediatric hospital-to-home discharge. DESIGN A systematic review and narrative synthesis. METHODS The search strategy identifies studies published between 2016 and 2023. The quality of the included studies was assessed using the Critical Appraisal Skills Programme checklists. The protocol of this review was not registered. A search of three electronic databases (PubMed, CINAHL and Web of Science) and a search in the reference lists of the included studies was conducted in February 2021 and June 2023. RESULTS Fifteen studies met the inclusion criteria. The essential elements identified are grouped into the following topics: emergency management, physiological needs, medical device and medications management, long-term management and short-term management. Nurses have a critical role in ensuring patient safety and quality of care, and the nurses' competence makes the difference in the discharge's related outcomes. Our results can help the nursing profession implement comprehensive discharge projects. Our results support the improvement of nurse-led paediatric discharge programmes. Nurse managers can identify the grey areas of therapeutic education provided in their units and work for their improvement. Following the implementation of therapeutic education on these topics, measuring the discharge's related outcomes could be interesting. This study addresses the problem of managing a safe and efficient nurse-led discharge in a paediatric setting. It presents evidence on the essential elements to promote a safe paediatric discharge at home. These could impact nursing practice by using them to implement project and discharge pathways. We have adhered to relevant EQUATOR guidelines-PRISMA guidelines for reporting systematic review. No patients, service users, caregivers or public members were involved in this study due to its nature (systematic review).
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Affiliation(s)
- Silvia Rossi
- Direction of Health ProfessionalsIRCCS Istituto Giannina GasliniGenovaItaly
| | - Mark Hayter
- Manchester Metropolitan UniversityManchesterUK
| | - Alice Zuco
- Direction of Health ProfessionalsIRCCS Istituto Giannina GasliniGenovaItaly
| | - Francesca Tappino
- Direction of Health ProfessionalsIRCCS Istituto Giannina GasliniGenovaItaly
| | - Roberta Tirone
- Direction of Health ProfessionalsIRCCS Istituto Giannina GasliniGenovaItaly
| | - Silvia Scelsi
- Direction of Health ProfessionalsIRCCS Istituto Giannina GasliniGenovaItaly
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Feldman SS, Kennedy KC, Nafziger SM, Orewa GN, Kpomblekou-Ademawou E, Hearld KR, Hall AG. Critical Success Factors for Addressing Discharge Inefficiency at a Large Academic Medical Center: A Lean Six Sigma Approach. J Nurs Care Qual 2022; 37:135-141. [PMID: 34446665 DOI: 10.1097/ncq.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delayed discharges can be a systemic issue. Understanding the systemic factors that contribute to discharge inefficiencies is essential to addressing discharge inefficiencies. PURPOSE This article reports on a Lean Six Sigma approach and the process to identifying inefficiencies and systemic barriers to early discharge in a large US academic medical center. METHODS A qualitative methodology guided this project. In particular, direct observation methods were used to help the project team identify factors contributing to discharge inefficiencies. RESULTS Overall, findings suggest that establishing consistent multidisciplinary team communication processes was a contributing factor to reducing the inefficiencies around discharges. On a more granular level, key barriers included disparate communication systems, disruptors (specifically Kaizen bursts), and unique role challenges. CONCLUSIONS This article provides a framework for addressing discharge inefficiencies. Because the output of the process, a critical contributor to the overall outcome, is often not analyzed, this analysis provides value to others contemplating the same or similar process toward discharge efficiency.
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Affiliation(s)
- Sue S Feldman
- Department of Health Service Administration (Drs Feldman, Hearld, and Hall, Mr Orewa, and Ms Kpomblekou-Ademawou), UAB Hospital Medicine (Dr Kennedy), University of Alabama at Birmingham; Department of Emergency Medicine, University of Alabama at Birmingham Medical Center (Dr Nafziger); and Tenet Healthcare, Dallas, Texas (Ms Kpomblekou-Ademawou)
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Cadel L, Guilcher SJT, Kokorelias KM, Sutherland J, Glasby J, Kiran T, Kuluski K. Initiatives for improving delayed discharge from a hospital setting: a scoping review. BMJ Open 2021; 11:e044291. [PMID: 33574153 PMCID: PMC7880119 DOI: 10.1136/bmjopen-2020-044291] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The overarching objective of the scoping review was to examine peer reviewed and grey literature for best practices that have been developed, implemented and/or evaluated for delayed discharge involving a hospital setting. Two specific objectives were to review what the delayed discharge initiatives entailed and identify gaps in the literature in order to inform future work. DESIGN Scoping review. METHODS Electronic databases and websites of government and healthcare organisations were searched for eligible articles. Articles were required to include an initiative that focused on delayed discharge, involve a hospital setting and be published between 1 January 2004 and 16 August 2019. Data were extracted using Microsoft Excel. Following extraction, a policy framework by Doern and Phidd was adapted to organise the included initiatives into categories: (1) information sharing; (2) tools and guidelines; (3) practice changes; (4) infrastructure and finance and (5) other. RESULTS Sixty-six articles were included in this review. The majority of initiatives were categorised as practice change (n=36), followed by information sharing (n=19) and tools and guidelines (n=19). Numerous initiatives incorporated multiple categories. The majority of initiatives were implemented by multidisciplinary teams and resulted in improved outcomes such as reduced length of stay and discharge delays. However, the experiences of patients and families were rarely reported. Included initiatives also lacked important contextual information, which is essential for replicating best practices and scaling up. CONCLUSIONS This scoping review identified a number of initiatives that have been implemented to target delayed discharges. While the majority of initiatives resulted in positive outcomes, delayed discharges remain an international problem. There are significant gaps and limitations in evidence and thus, future work is warranted to develop solutions that have a sustainable impact.
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Affiliation(s)
- Lauren Cadel
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Quality Division, Ontario Health, Toronto, Ontario, Canada
| | | | - Jason Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jon Glasby
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, UK
| | - Tara Kiran
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Quality Division, Ontario Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Lundereng ED, Dihle A, Steindal SA. Nurses' experiences and perspectives on collaborative discharge planning when patients receiving palliative care for cancer are discharged home from hospitals. J Clin Nurs 2020; 29:3382-3391. [PMID: 32533726 DOI: 10.1111/jocn.15371] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/03/2020] [Accepted: 05/24/2020] [Indexed: 01/24/2023]
Abstract
AIMS AND OBJECTIVES To explore nurses' experiences and perspectives on discharge collaboration when patients receiving palliative care for cancer are discharged home from hospitals. BACKGROUND Patients receiving palliative care for cancer experience multiple transitions between the hospital and their home. Poor discharge collaboration is a major cause of preventable hospital readmissions. Collaborative discharge planning could improve the care for these patients outside the hospital setting. Previous research has mostly been conducted in noncancer populations. Further research regarding both home care nurses' and hospital nurses' perspectives on care transitions is required. DESIGN A qualitative study with descriptive and explorative design. METHODS Data were collected through 10 individual, semi-structured interviews of nurses working at two oncology wards at a university hospital and home care services in four municipalities within the hospital's catchment area. Data were analysed using systematic text condensation. COREQ guidelines were adhered to in the reporting of this study. RESULTS Three categories emerged from the data analysis: lack of familiarity and different perceptions lead to distrust; inefficient communication creates a need for informal collaboration; and delayed discharge planning challenges collaboration. CONCLUSIONS The nurses lacked an understanding of each other's work situation, which created distrust, misunderstandings and misconceptions regarding each other's abilities to care for the patient. This led to inefficient communication, relying on individual knowledge, informal communication and personal networking. Delays in the discharge planning resulted in poorly prepared discharges often lacking necessary equipment and documentation. RELEVANCE TO CLINICAL PRACTICE To improve the care of patients receiving palliative care for cancer outside the hospital setting, better communication is a key factor to promote confidence and understanding between nurses working in different settings of health care.
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Affiliation(s)
- Elias David Lundereng
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Palliative treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Alfhild Dihle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Modas DAS, Nunes EMGT, Charepe ZB. Causas de atraso na alta hospitalar no cliente adulto: scoping review. Rev Gaucha Enferm 2019; 40:e20180130. [DOI: 10.1590/1983-1447.2019.20180130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/16/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo OBJETIVO Mapear a evidência existente sobre as causas de atraso na alta hospitalar no cliente adulto. MÉTODOS Efetuada revisão da literatura do tipo scoping review. Pesquisou-se na plataforma informática da Ebscohost, na PubMed e na literatura cinzenta, consultando-se as referências bibliográficas desses documentos. RESULTADOS Dos 22 artigos analisados verificou-se que o atraso na alta hospitalar se deve a causas relacionadas com os recursos da comunidade, designadamente a falta de vagas em unidades de saúde e motivos sociais; a causas organizacionais relacionadas com os cuidados de saúde; a causas individuais, destacando-se as questões familiares e financeiras; culminando nas causas organizacionais relacionadas com a gestão hospitalar. CONCLUSÃO O atraso na alta hospitalar é multifatorial, tornando-se necessário monitorizar o processo de internação, apostando-se num planejamento de alta antecipado.
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Tracking Discharge Delays: Critical First Step Toward Mitigating Process Breakdowns and Inefficiencies. J Nurs Care Qual 2016; 31:17-23. [PMID: 26166435 DOI: 10.1097/ncq.0000000000000141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reports on the development and evaluation of a mechanism designed for real-time tracking of discharge delays by bedside clinicians and the reporting of delays in a manner amenable to action. During the implementation phase, delay time totaled 23.6 days for 114 patients affected by a delay. More than one-half of delays (61.4%) occurred for patients whose discharge disposition was home to self-care.
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Tan YY, Blackford J. 'Rapid discharge': issues for hospital-based nurses in discharging cancer patients home to die. J Clin Nurs 2015; 24:2601-10. [PMID: 26010267 DOI: 10.1111/jocn.12872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2015] [Indexed: 01/21/2023]
Abstract
AIMS AND OBJECTIVES To explore issues for hospital-based nurses in arranging rapid home discharge for imminently dying cancer patients in a Singapore acute hospital. BACKGROUND Dying at home is an important measure of a 'good death'. For hospitalised terminally ill patients, achieving home death can be of paramount importance to them and their family. Nurses experience many challenges in discharging imminently dying cancer patients home, due to time limitations and complex needs of patients and their families. DESIGN Qualitative interpretive description. METHOD Using purposive sampling, 14 registered nurses from an oncology ward in a Singapore hospital were recruited to participate in individual, semi-structured interviews. RESULTS Nursing issues in facilitating rapid discharge fell into three categories: time, discharge processes and family preparation. Decisions to die at home appeared solely family/patient driven, and were made when death appeared imminent. Discharge then became time-critical, as nurses needed to complete multiple tasks within short timeframes. Stress was further exacerbated by nurses' inexperience and the infrequent occurrence of rapid discharge, as well as absence of standardised discharge framework for guidance. Together, the lack of time and discharge processes to enable smooth hospital-to-home transition potentially affected nurses' capacity to adequately prepare families, and may contribute to caregiver anxiety. CONCLUSION Rapid discharge processes are needed as sudden patient/family decisions to die at home will continue. Earlier involvement of palliative care and implementation of a discharge pathway can potentially help nurses address their multiple responsibilities to ensure a successful transition from hospital to home. RELEVANCE TO CLINICAL PRACTICE Recognition of nursing issues and challenges during rapid discharge has implications for clinical improvements in supporting nurses during this challenging situation. Results of this study can be used to inform the conceptualisation of clinical interventions to facilitate urgent discharges of imminently dying patients.
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Affiliation(s)
- Yung Ying Tan
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
| | - Jeanine Blackford
- School of Nursing & Midwifery, La Trobe University, Bundoora, Vic., Australia
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Noseworthy AM, Sevigny E, Laizner AM, Houle C, La Riccia P. Mental health care professionals' experiences with the discharge planning process and transitioning patients attending outpatient clinics into community care. Arch Psychiatr Nurs 2014; 28:263-71. [PMID: 25017560 DOI: 10.1016/j.apnu.2014.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/11/2014] [Accepted: 05/11/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care reform promotes delivery of mental health care in the community. Outpatient mental healthcare professionals (HCPs) are pressured to discharge patients. This study's purpose: to understand the experience and perceptions of mental HCPs with discharge planning and transitioning patients into community care. METHODS Twelve HCPs participated in semi-structured qualitative interviews. FINDINGS Three main categories: engaging in the discharge planning process, making the transition smooth, and guiding values emerged. A conceptual framework was created to explain the phenomenon. CONCLUSION HCPs valued strengthening partnerships and building relationships to ensure smooth transition. Sufficient resources and trust imperative for safe patient discharge.
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Affiliation(s)
| | - Elizabeth Sevigny
- McGill University Ingram School of Nursing, Montréal, Québec, Canada.
| | - Andrea M Laizner
- McGill University Health Centre, Royal Victoria Hospital-S11, Montréal, Québec, Canada.
| | - Claudine Houle
- McGill University Health Centre, Royal Victoria Hospital-S11, Montréal, Québec, Canada.
| | - Pina La Riccia
- McGill University Health Centre, Royal Victoria Hospital-S11, Montréal, Québec, Canada.
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Using the Red/Yellow/Green Discharge Tool to Improve the Timeliness of Hospital Discharges. Jt Comm J Qual Patient Saf 2014; 40:243-52. [DOI: 10.1016/s1553-7250(14)40033-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Graham J, Gallagher R, Bothe J. Nurses' discharge planning and risk assessment: behaviours, understanding and barriers. J Clin Nurs 2013; 22:2338-46. [DOI: 10.1111/jocn.12179] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Jane Graham
- Rehabilitation and Aged Care; Calvary Health Care; Sydney NSW Australia
| | - Robyn Gallagher
- Faculty of Nursing; St George Hospital; Sydney NSW Australia
| | - Janine Bothe
- Faculty of Nursing; St George Hospital; Sydney NSW Australia
- Midwifery and Health; University of Technology; Sydney NSW Australia
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An evidence-based case for the value of social workers in efficient hospital discharge. Health Care Manag (Frederick) 2011; 30:242-6. [PMID: 21808176 DOI: 10.1097/hcm.0b013e318225e1dd] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A study was undertaken to make an evidence-based case for the value of social workers in efficient discharge of patients from acute care hospitals and to assist hospital managers in making informed staffing decisions. Hospital administrative databases from March 1 to November 30, 2008, were used for the analysis of inpatient discharges on days when social workers were on vacation compared with days fully staffed with social workers. Two performance measures, daily discharge rate and average length of stay, were evaluated. During the study period, 1825 patients were discharged from the General Internal Medicine inpatient service. Team discharge rates were significantly lower on social work vacation Fridays versus regular Fridays. In contrast, the average length of stay for patients discharged on social work vacation Fridays was significantly shorter than that for patients discharged on regular Fridays. It was concluded that daily discharge rate better quantified the role of social work in patient discharge. More generally, these results provide preliminary support for the need for adequate social work staffing in timely and efficient patient discharge.
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Frank-Bader M, Beltran K, Dojlidko D. Improving Transplant Discharge Education Using a Structured Teaching Approach. Prog Transplant 2011; 21:332-9. [DOI: 10.1177/152692481102100413] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Context Nonadherence to posttransplant regimens is common in transplant patients and has the potential for devastating consequences, including acute rejection, graft loss, decreased quality of life, and even death. Comprehensive education of patients and families that improves their understanding of posttransplant regimens and selfcare techniques can increase adherence and improve outcomes. Transplant recipients have to learn a vast amount of complex information in a short period as they recover from major surgery and cope with the emotional stress of transplantation. It is not surprising that many patients report that they do not feel ready for discharge. Objective To describe the development, implementation, and outcomes of a comprehensive interdisciplinary patient education program. Design A quality improvement project. Setting A solid organ transplant unit of a large academic medical center. Participants In-hospital transplant patients and their families and the interdisciplinary team. Interventions A comprehensive discharge education program that integrated written materials, patient and clinical pathways, and discharge instructions. Main Outcome Measure Improved patient satisfaction with readiness for discharge and medication teaching. Results A postimplementation patient discharge survey using a 5-point Likert scale showed an increase in patients' understanding of medication dosage (3.6 to 4.6) and side effects (3.6 to 4.7), and satisfaction with the discharge teaching process (3.4 to 5.0).
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Affiliation(s)
| | - Karen Beltran
- New York University Langone Medical Center, New York
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