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Cadel L, Sandercock J, Marcinow M, Guilcher SJT, Kuluski K. A qualitative study exploring hospital-based team dynamics in discharge planning for patients experiencing delayed care transitions in Ontario, Canada. BMC Health Serv Res 2022; 22:1472. [PMID: 36463159 PMCID: PMC9719119 DOI: 10.1186/s12913-022-08807-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In attempt to improve continuity of patient care and reduce length of stay, hospitals have placed an increased focus on reducing delayed discharges through discharge planning. Several benefits and challenges to team-based approaches for discharge planning have been identified. Despite this, professional hierarchies and power dynamics are common challenges experienced by healthcare providers who are trying to work as a team when dealing with delayed discharges. The objective of this study was to explore what was working well with formal care team-based discharge processes, as well as challenges experienced, in order to outline how teams can function to better support transitions for patients experiencing a delayed discharge. METHODS: We conducted a descriptive qualitative study with hospital-based healthcare providers, managers and organizational leaders who had experience with delayed discharges. Participants were recruited from two diverse health regions in Ontario, Canada. In-depth, semi-structured interviews were conducted in-person, by telephone or teleconference between December 2019 and October 2020. All interviews were recorded and transcribed. A codebook was developed by the research team and applied to all transcripts. Data were analyzed inductively, as well as deductively through directed content analysis. RESULTS We organized our findings into three main categories - (1) collaboration with physicians makes a difference; (2) leadership should meaningfully engage with frontline providers and (3) partnerships across sectors are critical. Regular physician engagement, as equal members of the team, was recommended to improve consistent communication, relationship building between providers, accessibility, and in-person communication. Participants highlighted the need for a dedicated senior leader who ensured members of the team were treated as equals and advocated for the team. Improved partnerships across sectors included the enhanced integration of community-based providers into discharge planning by placing more focus on collaborative practice, combined discharge planning meetings, and having embedded and physically accessible care coordinators in the hospital. CONCLUSIONS Team-based approaches for delayed discharge can offer benefits. However, to optimize how teams function in supporting these processes, it is important to consistently collaborate with physicians, ensure senior leadership engage with and seek feedback from frontline providers through co-design, and actively integrate the community sector in discharge planning.
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Affiliation(s)
- Lauren Cadel
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, L5B1B8, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M5S3M2, Canada
| | - Jane Sandercock
- McMaster University, School of Rehabilitation Science, Hamilton, Canada
| | - Michelle Marcinow
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, L5B1B8, Canada
| | - Sara J T Guilcher
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, L5B1B8, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M5S3M2, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | - Kerry Kuluski
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, L5B1B8, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M7, Canada.
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Kuluski K, Cadel L, Marcinow M, Sandercock J, Guilcher SJT. Expanding our understanding of factors impacting delayed hospital discharge: Insights from patients, caregivers, providers and organizational leaders in Ontario, Canada. Health Policy 2022; 126:310-317. [DOI: 10.1016/j.healthpol.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022]
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Porgo TV, Moore L, Assy C, Neveu X, Gonthier C, Berthelot S, Gabbe BJ, Cameron PA, Bernard F, Turgeon AF. Development and Validation of a Hospital Indicator of Activity-Based Costs for Injury Admissions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:530-538. [PMID: 33840431 DOI: 10.1016/j.jval.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/07/2020] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To develop a hospital indicator of resource use for injury admissions. METHODS We focused on resource use for acute injury care and therefore adopted a hospital perspective. We included patients ≥16 years old with an Injury Severity Score >9 admitted to any of the 57 trauma centers of an inclusive Canadian trauma system from 2014 to 2018. We extracted data from the trauma registry and hospital financial reports and estimated resource use with activity-based costing. We developed risk-adjustment models by trauma center designation level (I/II and III/IV) for the whole sample, traumatic brain injuries, thoraco-abdominal injuries, orthopedic injuries, and patients ≥65 years old. Candidate variables were selected using bootstrap resampling. We performed benchmarking by comparing the adjusted mean cost in each center, obtained using shrinkage estimates, to the provincial mean. RESULTS We included 38 713 patients. The models explained between 12% and 36% (optimism-corrected r2) of the variation in resource use. In the whole sample and in all subgroups, we identified centers with higher- or lower-than-expected resource use across level I/II and III/IV centers. CONCLUSIONS We propose an algorithm to produce the indicator using data routinely collected in trauma registries to prompt targeted exploration of potential areas for improvement in resource use for injury admissions. The r2 of our models suggest that between 64% and 88% of the variation in resource use for injury care is dictated by factors other than patient baseline risk.
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Affiliation(s)
- Teegwendé V Porgo
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada
| | - Lynne Moore
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada.
| | - Coralie Assy
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada
| | - Xavier Neveu
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada
| | - Catherine Gonthier
- Unité d'évaluation en traumatologie et en soins critiques, Institut national d'excellence en santé et en services sociaux (INESSS), Québec, Canada
| | - Simon Berthelot
- Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada; Department of Family Medicine, Université Laval, Québec, Canada
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Francis Bernard
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Alexis F Turgeon
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Canada
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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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Kuluski K, Ho JW, Cadel L, Shearkhani S, Levy C, Marcinow M, Peckham A, Sandercock J, Willison DJ, Guilcher SJ. An alternate level of care plan: Co-designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges. Health Expect 2020; 23:1155-1165. [PMID: 32602628 PMCID: PMC7696114 DOI: 10.1111/hex.13094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/13/2020] [Accepted: 06/07/2020] [Indexed: 01/09/2023] Open
Abstract
Objective To engage with patients, caregivers and care providers to co‐design components of an intervention that aims to improve delayed hospital discharge experiences. Design This is a qualitative study, which entailed working groups and co‐design sessions utilizing World Café and deliberative dialogue techniques to continually refine the intervention. Setting and Participants Our team engaged with 61 participants (patients, caregivers and care providers) in urban and rural communities across Ontario, Canada. A 7‐member Patient and Caregiver Advisory Council participated in all stages of the research. Results Key challenges experienced during a delayed discharge by patients, caregivers and care providers were poor communication and a lack of care services. Participants recommended a communication guide to support on‐going conversation between care providers, patients and caregivers. The guide included key topics to cover and questions to ask during initial and on‐going conversations to manage expectations and better understand the priorities and goals of patients and caregivers. Service recommendations included getting out of bed and dressed each day, addressing the psycho‐social needs of patients through tailored activities and having a storyboard at the bedside to facilitate on‐going engagement. Discussion and Conclusions Our findings outline ways to meaningfully engage patients and caregivers during a delayed hospital discharge. Combining this with a minimal basket of services can potentially facilitate a better care experience and outcomes for patients, their care providers and families.
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Affiliation(s)
- Kerry Kuluski
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Julia W Ho
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Lauren Cadel
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Sara Shearkhani
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Charissa Levy
- Rehabilitative Care Alliance / GTA Rehab Network / Toronto ABI Network, Toronto, ON, Canada
| | - Michelle Marcinow
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Allie Peckham
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ, USA
| | - Jane Sandercock
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Donald J Willison
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Sara Jt Guilcher
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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Pellico-López A, Cantarero D, Fernández-Feito A, Parás-Bravo P, Cayón de Las Cuevas J, Paz-Zulueta M. Factors Associated with Bed-Blocking at a University Hospital (Cantabria, Spain) between 2007 and 2015: A Retrospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3304. [PMID: 31505726 PMCID: PMC6765863 DOI: 10.3390/ijerph16183304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 12/27/2022]
Abstract
Current studies on bed-blocking or delayed discharge for non-medical reasons report important variations depending on the country or setting under study. Research on this subject is clearly important as the current system reveals major inefficiencies. Although there is some agreement on the patient-related factors that contribute to the phenomenon, such as older age or a lack of functional ability, there is greater variability regarding environmental or organizational factors. This study sought to quantify the number of cases and days inappropriately spent in hospital and identify patient characteristics and healthcare service use associated with the total length of stay. All cases of delayed discharge were studied at the hospitalization units of a general university hospital in Northern Spain between 2007 and 2015. According to regression estimates, the following characteristics were related to a longer stay: higher complexity through (Diagnosis-Related Group) DRG weight, a diagnosis that implied a lack of functional ability, surgical treatment, having to wait for a destination upon final discharge or return home. After an initial increase, a reduction in delayed discharge was observed, which was maintained for the duration of the study period. Multi-component interventions related with discharge planning can favor a reduced inefficiency with fewer unnecessary stays.
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Affiliation(s)
- Amada Pellico-López
- Care Continuity Coordinator, Área VI SESPA, Urbanización Castañeda s/n. C.P., 33540 Arriondas, Principado de Asturias, Spain
- Research Group on Public Economics and Health, GIECONPSALUD, University of Cantabria, Avda de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain
| | - David Cantarero
- Research Group on Public Economics and Health, GIECONPSALUD, University of Cantabria, Avda de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain
- Faculty of Economics, University of Cantabria, Avda. de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain
| | - Ana Fernández-Feito
- Nursing Area, Department of Medicine, Faculty of Medicine and Health Sciences, University of Oviedo / ISPA. Avda Julián Clavería s/n. C.P., 33006 Oviedo, Principado de Asturias, Spain
| | - Paula Parás-Bravo
- Research Group on Public Economics and Health, GIECONPSALUD, University of Cantabria, Avda de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain
- Faculty of Nursing, University of Cantabria, Avda Valdecilla s/n. C.P., 39008 Santander, Cantabria, Spain
- IDIVAL, Grupo de Investigación en Enfermería. C/ Cardenal Herrera Oria s/n. C.P., 39011 Santander, Cantabria, Spain
| | - Joaquín Cayón de Las Cuevas
- Facultad de Derecho, University of Cantabria, Avda. de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n. C.P., 39011 Santander, Cantabria, Spain
| | - María Paz-Zulueta
- Research Group on Public Economics and Health, GIECONPSALUD, University of Cantabria, Avda de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain.
- Faculty of Nursing, University of Cantabria, Avda Valdecilla s/n. C.P., 39008 Santander, Cantabria, Spain.
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n. C.P., 39011 Santander, Cantabria, Spain.
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Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study. Injury 2019; 50:1192-1201. [PMID: 31000192 DOI: 10.1016/j.injury.2019.03.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/27/2019] [Accepted: 03/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Variations in adjusted costs have been observed among trauma centres in the United States but patient outcomes were not better in centres with higher costs. Attempts to improve injury care efficiency are hampered by insufficient patient-level information on resource use and on the drivers of resource use intensity. OBJECTIVES To estimate patient-level resource use for injury admissions, identify determinants of resource use intensity, and evaluate inter-hospital variations in resource use. METHODS We conducted a retrospective cohort study including ≥16-year-olds admitted to adult trauma centres in a mature, inclusive Canadian trauma system between 2014 and 2016. We extracted data from the trauma registry and hospital financial reports. We estimated resource use with activity-based costs, identified determinants of resource use intensity using a multilevel linear model and assessed the relative importance of each determinant with Cohen's f2. We evaluated inter-provider variations with intraclass correlation coefficients (ICC) and 95% confidence intervals. RESULTS We included 32,411 patients. Median costs per admission were $4857 (Quartiles 1 and 3 2961-8448). The most important contributors to total resource use were the medical ward (57%), followed by the operating room (OR; 23%) and the intensive care unit (13%). The strongest determinant of resource use intensity was discharge destination (Cohen's f2 = 7%). The most resource intense patient group was spinal cord injuries with $11,193 (7115-17,606) per admission. While resource use increased with increasing age for the medical ward, it decreased with increasing age for the OR. Resource use was 18% higher in level I centres compared to level IV centres and we observed significant variations in resource use across centres (ICC = 5% [4-6]), particularly for the OR (28% [20-40]). CONCLUSIONS Resource use for acute injury care in Quebec is not solely due to the clinical status of patients. We identified determinants of resource use that can be used to establish evidence-based resource allocations and improve injury care efficiency. The method we developed for estimating patient-level, in-hospital resource use for injury admissions and identifying related determinants could be reproduced using local trauma registry data and our unit costs or unit costs specific to each setting.
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Kuluski K, Im J, McGeown M. "It's a waiting game" a qualitative study of the experience of carers of patients who require an alternate level of care. BMC Health Serv Res 2017; 17:318. [PMID: 28464878 PMCID: PMC5414131 DOI: 10.1186/s12913-017-2272-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 04/26/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Delayed hospital discharge (also known as Alternate Level of Care or ALC) is a global health care quality issue with negative implications for people (e.g., functional decline) and the health care system (e.g., costly interruptions in hospital flow and procedures). ALC disproportionately impacts people with cognitive impairment, and insight into the needs and experiences of this specific sub population and their carers is lacking. The purpose of this study was to understand the hospital experience of carers (e.g., family members) of patients with ALC and cognitive impairment who were waiting for long-term care from the hospital. METHODS This is a qualitative descriptive study entailing 12 semi-structured interviews with 15 carers of patients with ALC from three hospitals in Northwestern Ontario. Interviews were conducted between October 2015 and February 2016. Two reviewers thematically analyzed the interview data. RESULTS Five core themes were identified from the interview data: patient over person, uncertain and confusing process, inconsistent quality in care delivery, carers addressing gaps in the system, and personalization of long-term care. CONCLUSIONS Waiting for long-term care from the hospital is a stressful and uncertain time for family carers. ALC is an 'in-between' phase when patients and carers may be at their most vulnerable yet receive the least care from the formal care system. Carers provide critical insight into the needs and behaviors of patients as well as processes that need to be improved to enhance their experience. Such insights will help health systems internationally as they grapple with the issue of ALC whilst trying to optimize engagement with patients and their families.
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Affiliation(s)
- Kerry Kuluski
- Centre for Education and Research on Aging and Health, Lakehead University, 1 Bridgepoint Drive, M4M 2B5, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Centre for Education and Research on Aging and Health, Lakehead University, Thunder Bay, ON, Canada.
| | - Jennifer Im
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mary McGeown
- Centre for Education and Research on Aging and Health, Lakehead University, 1 Bridgepoint Drive, M4M 2B5, Toronto, ON, Canada
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What's the hold up? Factors contributing to delays in discharge of trauma patients after medical clearance. Am J Surg 2014; 208:969-73; discussion 972-3. [DOI: 10.1016/j.amjsurg.2014.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 11/24/2022]
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