Readiness for hospital discharge and influencing factors: a cross-sectional study on patients discharged with tubes from the department of hepatobiliary surgery

Factors affecting the readiness for hospital discharge of initially treated pulmonary tuberculosis patients in China: a phenomenological study

BACKGROUND

Despite readiness for hospital discharge widespread popularity since readiness for hospital discharge introduction in 1979 and extensive study, readiness for hospital discharge among pulmonary tuberculosis (PTB) patients has not yet been investigated. Moreover, the factors influencing this process remain unclear.

OBJECTIVE

The objective of this study was to investigate the factors influencing readiness for hospital discharge in initially treated PTB patients using the capability, opportunity, motivation-behavior (COM-B) model.

METHODS

This phenomenological study was conducted from December 2023 to March 2024. Face-to-face individual interviews were conducted with 18 initially treated patients with PTB according to a semistructured interview guide developed on the basis of the COM-B model. The interview data were subjected to analysis using NVivo 14 software and Colaizzi's method.

RESULTS

As a result, 6 themes and 14 subthemes were identified. Physical capability for readiness for hospital discharge (subthemes included poor health status, early acquisition of adequate knowledge about PTB, inadequate knowledge about readiness for hospital discharge), psychological capability for readiness for hospital discharge(subthemes included false perceptions about readiness for hospital discharge, high treatment adherence), physical opportunity for readiness for hospital discharge (subthemes included high continuity of transition healthcare, insufficient financial support, insufficient informational support), social opportunity for readiness for hospital discharge (subthemes included stigmatization, inadequate emotional support), reflective motivation for readiness for hospital discharge (subthemes included lack of reflection on coping with difficulties, intention to develop a readiness for hospital discharge plan), and automatic motivation for readiness for hospital discharge (subthemes included strong desire to be cured, negative emotions).

CONCLUSION

We established factors related to readiness for hospital discharge in initially treated PTB patients in terms of capability, opportunity and motivation, which can inform the future development of readiness for hospital discharge plans. To improve patients' readiness for hospital discharge, patients need to be motivated to plan and desire readiness for hospital discharge, patients' knowledge and treatment adherence should be improved, and patients' transition healthcare continuity and emotional support should be focused on. Moreover, the quality of readiness for hospital discharge and discharge education should be assessed in a timely manner to identify impeding factors and provide interventions.

Position Adherence in Patients Underwent Pars Plana Vitrectomy with Silicone Oil Tamponade

Introduction

Position adherence of patients with Pars Plana Vitrectomy with Silicone Oil Tamponade after discharge is of positive significance. However, patients undergoing a day surgery makes the quality of discharge teaching and readiness for hospital discharge is insufficient, which will influence their position adherence at home.

Aim

This study aimed to find the correlation of discharge teaching, readiness for hospital discharge, and position adherence in patients who underwent PPV with silicone oil tamponade from the day ward.

Methods

This was a cross-sectional survey. One hundred ninety-four patients with day surgery were recruited by convenient sampling from Zhongshan Ophthalmic Center, China. Data were collected using the quality of discharge teaching scale, readiness for hospital discharge scale, and position adherence scale.

Results

Patients' education level, residence, poor postoperative vision, ophthalmic surgery history, and quality of discharge teaching are the main factors of readiness for discharge. Only 41(21%) patients had good position adherence, and education level and readiness for discharge are the main factors of position adherence.

Discussion

Discharge teaching improves patients' knowledge and competence of self-care and helps patients prepare for the transition from hospital to home, and readiness for hospital discharge significantly influences position adherence after discharge and indirectly plays a vital role in postoperative vision recovery and surgical effect.

Development and Validation of a Patient Discharge Readiness Scale for Daytime Cataract Surgery (DRS-CAT)

PURPOSE

To ensure the safety of patients discharged from the hospital, a nurse-assessed scale for outpatient cataract surgery patients was constructed to provide a special tool for cataract patients' discharge readiness evaluation.

DESIGN

This is a methodological study.

METHODS

The development of the tool was completed between 2021 and 2022. Based on the literature review and qualitative interviews, the initial entry pool of the discharge readiness scale was established. After consultation with Delphi experts, the preliminary scale was tested by 312 participants to screen items and test reliability and validity. The analysis included internal consistency, content validity, and construct validity. The Strengthening the Reporting of Observation studies in Epidemiology (STROBE) checklist was used as the reporting guideline for this study.

FINDINGS

The final Discharge Readiness Scale for Cataract surgery consists of 21 items in five dimensions: cognition of discharge readiness, personal status, mastery of health education knowledge, coping capacity, and social support. Five common factors were extracted from the exploratory factor analysis, and they explained 70.12% of the total variance. All of the indexes of the confirmatory factor analysis were within the theoretical allowable range. The Cronbach's α of the total scale was 0.903, and the scale-level content validity index/average variance extracted was 0.99.

CONCLUSIONS

The Discharge Readiness Scale for Cataract surgery, evaluated by nurses, has good reliability and validity and can be used to determine the discharge readiness of cataract patients undergoing day surgery.

Barriers and facilitators of readiness for hospital discharge in patients with myocardial infarction: a qualitative study: quality improvement study

Background

Readiness for hospital discharge (RHD) in patients with myocardial infarction (MI) is a key concept in the discharge process. This study was conducted to explain the barriers and facilitators of preparation for discharge in patients with MI.

Materials and methods

A qualitative study was conducted using conventional content analysis from April 2021 to 2022. Data collection was done in a targeted manner through semi-structured interviews until the data saturation stage. Nineteen participants (11 patients, 3 family members, and 5 healthcare team) were interviewed. Data analysis was done in eight steps according to the suggested steps of Graneheim and Lundman. MAXQDA18 software was used for coding.

Results

From the interviews, 348 primary codes, 11 sub-categories, and 5 categories were extracted. Finally, after continuous analysis and comparison of interviews, codes, and categories, two themes including "supporting platform" and "caring atmosphere" were extracted, which were the result of the participants' experience and understanding of the barriers and facilitators of RHD. The supporting platform included "family support" and "social support" and the caring atmosphere included "care gaps" and "professional healthcare team performance".

Conclusion

The results of this study indicate several factors affecting RHD in heart attack patients. According to the results of the study, the participation of the patient, family, healthcare team, and community in creating RHD is recommended. It is also suggested to pay attention to these factors in care and treatment planning to help improve health and control complications and prevent re-hospitalization in these patients.

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.

Impact of COVID-19 visitation policies and hospital capacity on discharge readiness in medicine patients

Background

COVID-19 impacted the experience of being hospitalized with the widespread adoption of strict visitation policies to ensure healthcare worker safety. One result was decreased time of caregivers at the bedside of hospitalized patients.

Objective

To understand the impact of pandemic-related system effects on patient-reported discharge preparation.

Design

This mixed methods study included interviews with a sample of discharged patients during April 2020, and quantitative hospital data from April 2020 to February 2021.

Participants

616 patients completed a measure of discharge readiness on their day of discharge and 38 patients completed interviews about their discharge experiences.

Main measures

Readiness for discharge (RHDS), visitation policies, ward structure changes, COVID-19-unit census, time into the COVID-19 pandemic, patient characteristics (age, sex, race/ethnicity), admission type (planned/unplanned, for COVID-19), and discharge destination (home, home health, skilled nursing).

Key results

Adult patients aged 30-45 (vs. young and older adult patients) and those being discharged to places other than home (e.g., skilled nursing facility) or to out-of-state residences report lower readiness (p < 0.05) on RHDS. Patient interviews revealed some gaps in discharge communication but, overall, patients expressed high discharge readiness and few concerns about how COVID-19 system changes impacted their discharge preparation.

Conclusions

While there is some evidence that visitation policies and unit census may impact patient perceptions of discharge preparation, personal characteristics contributed more significantly to discharge readiness than system changes during COVID-19. Participant interviews demonstrated agreement, as most participants were discharged home and identified strong personal feelings of readiness for discharge.Clinical trials registration: ClinicalTrials.gov ID NCT04248738, https://clinicaltrials.gov/ct2/show/NCT04248738.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44250-023-00060-8.

Readiness for hospital discharge post-initial invasive percutaneous transhepatic biliary drainage: A mixed-methods study

This study explores perceptions regarding hospital discharge readiness among patients with post-first invasive percutaneous transhepatic biliary drainage (PTBD), family caregivers, and healthcare providers who are involved during the discharge period. A convergent mixed-method design was applied. A purposive sample of 30 patients completed a scale measuring readiness for hospital discharge, and 30 participants, including patients, family caregivers, and healthcare providers, participated in in-depth interviews. Descriptive analyses were combined with quantitative data, thematic analyses with qualitative data, and joint displays with mixed analyses. Findings indicate that readiness for hospital discharge was high, the expected support subscale was at the highest possible level, and the personal status subscale was at the lowest level. Three main themes emerged from an analysis of the interview transcripts: improved health conditions, self-care knowledge, and homecare preparedness. Self care knowledge had three sub-themes: taking care of biliary drainage, consuming a suitable diet, and observation of abnormal symptoms. Being ready for hospital discharge contributes to a safer transition from hospital to home. Healthcare providers need to reconsider the criteria for discharge and clarify patients' individual needs. Patients, family caregivers, and healthcare providers need to be prepared for hospital discharge.

Status Quo and Influencing Factors of Discharge Readiness of Patients with Bilateral Ureteral Stoma After Radical Cystectomy

Bladder cancer is a common malignancy of the urinary system, which occurs mostly in elderly men, and the incidence is increasing year by year. To analyze the status quo and related factors of discharge readiness of patients with bilateral ureteral stoma after radical cystectomy, a retrospective, noncomparative was performed. 544 patients with bilateral ureteral stoma after radical cystectomy in our hospital from December 2018 to December 2020 were selected. The self-designed questionnaire, discharge readiness scale (RHDS) and discharge guidance quality scale (QDTS) were used to investigate the general data, and multiple linear regression was used to analyze the related influencing factors. The total score of RHDS was (72.57 ± 18.56) and the total score of QDTS was (105.63 ± 24.18); the total score of RHDS was positively correlated with the total score of QDTS (r = 0.882, p = 0.000); the results of multiple linear regression showed that age, discharge direction and care mode were the main factors influencing the discharge readiness of patients (p < 0.05). In conclusions, the discharge readiness of patients with bilateral ureteral stoma after radical cystectomy is in the medium level, and there is a large space for improvement. Nurses should strengthen the guidance and nursing of patients’ discharge preparation to reduce the incidence of postoperative complications and readmission rate.

Discharge teaching, patient-reported discharge readiness and postsurgical outcomes in gynecologic patients undergoing day surgery: a generalized estimating equation

Background

Gynecologic patients undergoing day surgery are discharged in an intermediate stage of recovery. The quality of discharge teaching and discharge readiness are important to patients’ postsurgical outcomes, but little research has focused on them.

Methods

Quality of discharge teaching and discharge readiness were measured, and Spearman correlations were conducted. Postsurgical outcomes were recorded on postoperative Day 1, postoperative Day 7, and postoperative Day 28. Generalized estimating equations were used to explore factors that influence postsurgical outcomes.

Results

Discharge teaching was verified to be positively correlated with the discharge readiness of participants. The generalized estimating equations indicated that discharge teaching skills, effects of doctors and nurses, patient-reported physical conditions and social support following discharge were protective factors for postsurgical outcomes.

Conclusions

Doctors and nurses should improve discharge teaching skills and effects to improve the postsurgical outcomes of gynecological patients undergoing day surgery. At discharge, doctors and nurses should assess patients’ physical condition and facilitate a social support system.

Factors of Parents-Reported Readiness for Hospital Discharge in Children with Acute Leukemia: A Cross-Sectional Study

Aim

The aim of this study is to investigate the existing status and to explore the influencing factors of parents-reported readiness for hospital discharge in children with acute leukemia (AL) in China and to propose optimizing pathways and recommendations of discharge readiness for clinical reference.

Methods

A cross-sectional survey was conducted for the 122 children with AL who were discharged from the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University; their parents were investigated by using the modified Chinese version of Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). Data were collected between September 2020 and May 2021.Univariate analysis and multivariate logistic regression analysis were performed to explore the influencing factors of readiness for hospital discharge.

Results

The 122 children with AL included 52 females and 70 males with mean age 6.08 years. The total RHDS score was 7.7 ± 1.2, and 68.9% of the participants had high readiness for hospital discharge (RHDS score >7). The total QDTS score was 7.6 ± 2.0. Parent marital status (OR = 4.86, 95% CI: 1.31-18.05), education status (OR = 3.86, 95% CI: 1.18-12.55), family per capita monthly income (OR = 1.08, 95% CI: 1.01-2.99), and high QDTS (OR = 1.56, 95% CI: 1.11-2.68) were risk factors for high RHDS.

Conclusions

Our data suggest parents of children with AL had high readiness for hospital discharge and had the ability to take care of their children after discharge. Parental marital status, education status, QDTS score, and family per capita monthly income were independently associated with high RHDS.