Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers’ perceptions

Abstract

BackgroundThe complex process of discharging patients from acute care to community care requires a multifaceted interaction between all health care providers and patients. Poor communication in a patient’s discharge can result in post hospital adverse events, readmission, and mortality. Because of the gravity of these problems, discharge planning has been emphasized as a potential solution. The purpose of this paper is to identify communication barriers to effective discharge planning in an acute care unit of a tertiary care center and to suggest solutions to these barriers.MethodsHealth care providers provided comments to a single open-ended question: “What are the communication barriers between the different health care providers that limit an effective discharge of patients from Unit 36?” We conducted qualitative thematic analysis by identifying themes related to communication barriers affecting a successful discharge process.ResultsThree broad themes related to barriers to the discharge process were identified: communication, lack of role clarity and lack of resources. We also identified two themes for opportunities for improvement, ie, structure and function of the medical team and need for leadership.ConclusionWhile it was evident that poor communication was an overarching barrier identified by health care providers, other themes emerged. In an effort to increase inter-team communication, “bullet rounds”, a condensed form of discharge rounds, were introduced to the medical teaching unit and occurred on a daily basis between the multidisciplinary team. To help facilitate provider-patient communication, electronic transfer of care summaries were suggested as a potential solution. To help role clarity, a discharge coordinator and/or liaison was suggested. Communication can be enhanced through use of electronic discharge summaries, bullet rounds, and implementation of a discharge coordinator(s). The findings from this study can be used to aid future researchers in devising appropriate discharging strategies that are focused around the patient and inter-health care provider communication.

Barriers to timely discharge from the general medicine service at an academic teaching hospital

“…Patients cleared for discharge late in the day often have a delayed discharge as transport and acceptance at a facility are difficult. Poor communication both between members of the care team and between patients and providers can delay confirmation of discharge and impact patient readiness for discharge 3 10 11. Finally, hospitals face financial pressure to avoid readmission, as patients who return within 30 days are often not eligible for insurance coverage and hospitals can face financial penalties from Medicare 12…”

Experiences of nurse case managers within a central discharge planning role of collaboration between physicians, patients and other healthcare professionals: A sociocultural qualitative study

“…In the study by Okoniewska et al. (), communication was identified:

‘as an important factor influencing an effective discharge process’. Furthermore, successful collaboration can reduce or even prevent life threatening medical errors

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“…A further issue reported by Okoniewska et al. () is that lack of role clarity of NCMs can lead to misinterpretation of the role by others. This is an important issue within collaborative working aimed at the best interests of the patient because referral of complex cases to the NCM is incumbent on other healthcare professionals (HCPs).…”

Bedside nurses’ roles in discharge collaboration in general internal medicine: Disconnected, disempowered and devalued?

“…Physicians in these settings have pressures to prioritize their decision‐making around patient flow with an increasing emphasis on the value of teaching residents about safe discharge (Greysen, Schiliro, Horwitz, Curry, & Bradley, ; Schoenborn & Christmas, ). New discharge professional roles have been created to facilitate admissions and discharge in acute care medical units (Okoniewska et al., ). Nurses in managerial roles across a range of hospitals units have engaged in ‘organizing work’ that entails sophisticated technical, organizational and social skills (Allen, ); this has also been reported in the GIM context (Goldman et al., ).…”