Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals

Abstract

BackgroundStudies have shown that effective discharge planning is one of the key factors related to the quality of inpatient care and unnecessary hospital readmission. The perception and understanding of hospital discharge by health professionals is important in developing effective discharge planning. The aims of this present study were to explore the perceived quality of current hospital discharge from the perspective of health service providers and to identify barriers to effective discharge planning in Hong Kong.MethodsFocus groups interviews were conducted with different healthcare professionals who were currently responsible for coordinating the discharge planning process in the public hospitals. The discussion covered three main areas: current practice on hospital discharge, barriers to effective hospital discharge, and suggested structures and process for an effective discharge planning system.ResultsParticipants highlighted that there was no standardized hospital-wide discharge planning and policy-driven approach in public health sector in Hong Kong. Potential barriers included lack of standardized policy-driven discharge planning program, and lack of communication and coordination among different health service providers and patients in both acute and sub-acute care provisions which were identified as mainly systemic issues. Improving the quality of hospital discharge was suggested, including a multidisciplinary approach with clearly identified roles among healthcare professionals. Enhancement of health professionals' communication skills and knowledge of patient psychosocial needs were also suggested.ConclusionsA systematic approach to develop the structure and key processes of the discharge planning system is critical in ensuring the quality of care and maximizing organization effectiveness. In this study, important views on barriers experienced in hospital discharge were provided. Suggestions for building a comprehensive, system-wide, and policy-driven discharge planning process with clearly identified staff roles were raised. Communication and coordination across various healthcare parties and provisions were also suggested to be a key focus.

A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning

“…Pethybridge (2004) reported on unidisciplinary, multidisciplinary and transdisciplinary types of leadership and teamworking, each type suggested variations in how healthcare professionals interacted and worked together. A repeated theme in these studies on discharge in acute care is a lack of clarity about health care professionals' roles and responsibilities and problems with communication between professionals, with a shared concern that no one takes overall responsibility for discharge (Connolly et al, 2009;Greysen et al, 2012b;Pethybridge, 2004;Wong et al, 2011).…”

“…Problems with communication and discharge have been attributed to professional hierarchy and insufficient contact among professionals (Greysen et al, 2012b;Wong et al, 2011). Factors identified as important to effective interprofessional collaboration and teamwork in discharge include sharing of information, trust, respect, communication, a learning culture and facilitative leadership (Pethybridge, 2004;Reeves, Lewin, Espin & Zwarenstein 2010).…”

Orientações Em Saúde No Processo De Alta Hospitalar Em Usuários Reinternados Do Sistema Único De Saúde

“…Uma das exigências educacionais atuais em saúde, de acordo com a OMS (21) , é a busca e aplicação de estratégias que beneficiem as atitudes de saúde e o envolvimento consciente dos cidadãos na superação de dúvidas e temores relacionados aos cuidados a serem implementados no processo saúde-doença, sem restrições geográficas ou socioculturais. Há a necessidade de estabelecer um protocolo de orientações para alta, de modo a facilitar e melhorar sua efetividade (22) . O processo de alta envolve um trabalho em conjunto, desde as orientações antes da alta e a realização de encaminhamentos para continuidade à assistência pela equipe multiprofissional, o que pode influenciar assim, no índice de reinternações (23) .…”

Discharge planning: Narrated by nursing staff in primary healthcare and their concerns about using video conferencing in the planning session – An interview study

“…Difficulties in discharge planning have been an area of concern for more than 20 years and the challenge of improving the planning session and addressing communication between professions is described in a comparative study based on data from Sweden and the UK [3] . However, it would seem that problems related to communication among participants in the traditional discharge planning process are examined in many ways [18][19][20] . Person-centred nursing, where the nursing staff establish relationships with the patient, and a more modern way of communicating are perhaps needed if progress is to be made in this area [21] .…”

“…Wong et al found in a qualitative study from Hong Kong that barriers to effective discharge planning were lack of standardised, hospital-wide discharge planning and a policy-driven approach. A further potential barrier was lack of communication and co-ordination among different stakeholders and patients [20] . Difficulties in discharge planning have been an area of concern for more than 20 years and the challenge of improving the planning session and addressing communication between professions is described in a comparative study based on data from Sweden and the UK [3] .…”