Discharge planning in mental healthcare settings: A review and concept analysis

Abstract

To ensure a safe transition of mental health patients from hospital to community settings, greater attention is being given to discharge planning. However, assessing the quality of discharge planning has been challenging due to wide variations in its definition. To facilitate evaluation of discharge planning, its meaning in the mental health literature was systematically explored. This concept analysis is part of a larger study to develop an instrument to measure the quality of discharge planning processes in mental health care. Walker and Avant's (2011) concept analysis approach was adopted to provide a comprehensive definition of discharge planning. Electronic databases and grey literature were searched and analysed according to Grant and Booth's (2009) systematic search and review process. Literature published between 1900 and 2018 was reviewed. Forty-nine articles meeting the inclusion criteria were included in the analysis. Discharge planning is a complex, multifaceted concept with six defining attributes: comprehensive needs assessment; collaborative, patient-centered care; resource availability management; care and service coordination; discharge planner role; and a discharge plan. Discharge planning begins with the initial rapid assessment and symptom stabilization of a patient on admission, coincides with treatment planning, and is associated with hospital readmissions and continuity of care. The mental health literature was reviewed to analyse different interpretations of discharge planning. The conceptual definition provided can assist healthcare providers, organizational leaders, and policymakers to design and implement effective discharge planning policies and guidelines. Providing clarity regarding discharge planning also provides a critical foundation for developing an instrument.KEY WORDS: health services administration, mental health services, patient discharge, psychiatric nursing, qualitative research.

The factors of patient‐reported readiness for hospital discharge in patients with depression: A cross‐sectional study

“…However, as the average length of stay is regarded as an important index used to measure the quality of medical services and management level of hospitals (Daynes et al., 2016; Yiu et al., 2011), patients’ treatment time in hospitals is becoming shorter (Xiao et al., 2019). For example, the standard length of stay was 8 to 14 days in the 1950s but declined to less than 2 days in the mid‐1990s in the USA (Weiss et al., 2004), and the average length of stay in our hospital decreased from 9.60 to 7.80 days from 2015 to 2019.…”

“…Furthermore, due to the increasing economic pressure on health systems, reducing the hospital length of stay has become a pervasive method used to address the cost containment and fiscal pressures of inpatient mental health services (Xiao et al., 2019). Consequently, the time available to prepare patients for discharge has decreased (Mabire, et al., 2015; Nakanishi et al., 2015).…”

“…For example, 29.17% of psychiatric patients were readmitted to a hospital during a year of follow-up (Baeza et al, 2018) and 5.2%-5.4% of patients with depression had at least 1 readmission within 30 days of discharge (Citrome et al, 2019). Furthermore, due to the increasing economic pressure on health systems, reducing the hospital length of stay has become a pervasive method used to address the cost containment and fiscal pressures of inpatient mental health services (Xiao et al, 2019). Consequently, the time available to prepare patients for discharge has decreased Nakanishi et al, 2015).…”

Readiness for Hospital Discharge of Adult Patients with Major Depressive Disorder in China: A Cross-Sectional Study

“… 3 However, due to increasing economic pressure on health systems, reducing the length of hospitalization has become a default rule adopted to control costs and deal with the fiscal pressures of inpatient mental health services. 4 Accordingly, the time allotted for patients’ preparation for discharge has been shortened. 5 As a result, most patients with MDD are discharged with residual symptoms.…”

Leaving rehab: enhancing transitions into stable housing

“…International research evidence, including detailed program evaluations in diverse sites, indicates that detailed transition planning, and careful coordination between health and social services are central to successful reintegration into stable housing for individuals leaving residential treatment for either substance use disorders and/or mental health problems (Aubrey, Goering et al 2016;Holmes, Carlisle et al 2017;USDHUD 2007). Effective and coordinated transition planning has also been shown to reduce the subsequent incidence of service contact for individuals with a mental health diagnosis (see Xiao, Tourangeau et al 2019). Reports also confirm the role of discharge planning in reducing relapse rates among individuals leaving residential treatment for substance use disorders (see Ritter, Berends et al 2014).…”