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Smith H, Grindey C, Hague I, Newbould L, Brown L, Clegg A, Thompson C, Lawton R. Reducing delayed transfer of care in older people: A qualitative study of barriers and facilitators to shorter hospital stays. Health Expect 2022; 25:2628-2644. [PMID: 36193616 DOI: 10.1111/hex.13588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/11/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Growing numbers of older patients occupy hospital beds despite being 'medically fit' for discharge. These Delayed Transfers of Care amplify inefficiencies in care and can cause harm. Delayed transfer because of family or patient choice is common; yet, research on patient and family perspectives is scarce. To identify barriers to, and facilitators of, shorter hospital stays, we sought to understand older people's and caregivers' thoughts and feelings about the benefits and harms of being in hospital and the decisions made at discharge. METHODS A multimethod qualitative study was carried out. Content analysis was carried out of older people's experiences of health or care services submitted to the Care Opinion online website, followed by telephone and video interviews with older people and family members of older people experiencing a hospital stay in the previous 12 months. RESULTS Online accounts provide insight into how care was organized for older people in the hospital, including deficiencies in care organization, the discharge process and communication, as well as how care was experienced by older people and family members. Interview-generated themes included shared meanings of hospitalization and discharge experiences and the context of discharge decisions including failure in communication systems, unwarranted variation and lack of confidence in care and lack of preparation for ongoing care. CONCLUSION Poor quality and availability of information, and poor communication, inhibit effective transfer of care. Communication is fundamental to patient-centred care and even more important in discharge models characterized by limited assessments and quicker discharge. Interventions at the service level and targeted patient information about what to expect in discharge assessments and after discharge could help to address poor communication and support for improving discharge of older people from hospital. PATIENT OR PUBLIC CONTRIBUTION The Frailty Oversight Group, a small group of older people providing oversight of the Community Aging Research 75+ study, provided feedback on the research topic and level of interest, the draft data collection tools and the feasibility of collecting data with older people during the COVID-19 pandemic. The group also reviewed preliminary findings and provided feedback on our interpretation.
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Affiliation(s)
- Helen Smith
- Improvement Science Theme, NIHR Applied Research Collaboration Yorkshire and Humber, Bradford Institute for Health Research, Bradford, UK
| | - Chloe Grindey
- Improvement Science Theme, NIHR Applied Research Collaboration Yorkshire and Humber, Bradford Institute for Health Research, Bradford, UK
| | - Isabel Hague
- Improvement Science Theme, NIHR Applied Research Collaboration Yorkshire and Humber, Bradford Institute for Health Research, Bradford, UK
| | - Louise Newbould
- Social Policy Research Unit (SPRU), University of York, York, UK
| | - Lesley Brown
- Academic Unit for Aging and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Andrew Clegg
- Academic Unit for Aging and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Carl Thompson
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Hunt-O'Connor C, Moore Z, Patton D, Nugent L, Avsar P, O'Connor T. The effect of discharge planning on length of stay and readmission rates of older adults in acute hospitals: A systematic review and meta-analysis of systematic reviews. J Nurs Manag 2021; 29:2697-2706. [PMID: 34216502 DOI: 10.1111/jonm.13409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/30/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
AIM To examine the effectiveness of discharge planning on length of stay and readmission rates among older adults in acute hospitals. BACKGROUND Discharge planning takes place in all acute hospital settings in many forms. However, it is unclear how it contributes to reducing patient length of stay in hospital and readmission rates. METHODS Seven systematic reviews were identified and examined. All of the systematic reviews explored the impact of discharge planning on length of stay and readmission rates. RESULTS A limited meta-analysis of the results in relation to length of stay indicates positive finding for discharge planning as an intervention (MD = -0.71(95% CI -1.05,-0.37; p = .0001)). However, further analysis of the broader findings in relation to length of stay indicates inconclusive or mixed results. In relation to readmission rates both meta-analysis and narrative analysis point to a reduced risk for older people where discharge planning has taken place (RR = 0.78 (95% CI: 0.72, 0.84; p = .00001)). The ability to synthesize results however is severely hampered by the diversity of approaches to research in this area. IMPLICATIONS FOR NURSING MANAGEMENT It is unclear what impact discharge planning has on length of stay of older people. Indeed, while nurse mangers will be interested in gauging this impact on throughput and patient flow, it is questionable if length of stay is the correct outcome to measure when studying discharge planning as good discharge planning may increase length of stay. Readmission rates may be a more appropriate outcome measure but standardization of approach needs to be considered in this regard. This would assist nurse managers in assessing the impact of discharge planning processes.
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Affiliation(s)
- Caroline Hunt-O'Connor
- St James's Hospital, Dublin, Ireland.,RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland
| | - Zena Moore
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Lida Institute, Shanghai, China.,Faculty of Medicine and Health Sciences, UGent, Ghent University, Ghent, Belgium.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Declan Patton
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda Nugent
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia
| | - Pinar Avsar
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Tom O'Connor
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Lida Institute, Shanghai, China.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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