Risk of Falls after Hospital Discharge

Mahoney, Jane; Sager, Mark A.; Dunham, Nancy Cross; Johnson, Jill L.

doi:10.1111/j.1532-5415.1994.tb01750.x

Cited by 186 publications

(105 citation statements)

References 44 publications

(74 reference statements)

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“…Research highlights a number of common discharge-related risks associated, for example, with the management of medicines, the provision of appropriate health and social care, incomplete tests and scans, the fitting and use of home adaptation, and the risks of falls, infections or sores. [17][18][19][20][21][22][23][24][25][26][27][28] The underlying sources of these risks can range from factors related to the patient's condition or comorbidities, to the assessment of patient need, the availability of specialist resources in the community, and wider organisational and cultural factors. For example, research shows that the patient's condition, such as hip fracture, and other comorbidities, especially cognitive function and fragility, can represent a cluster of risks, particularly for older patients, that can complicate the discharge process.…”

Section: Hospital Discharge and Patient Safety: Reviews Of The Literamentioning

confidence: 99%

An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge

Waring

Marshall

Bishop

et al. 2014

Health Services and Delivery Research

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BackgroundHospital discharge is a vulnerable stage in the patient pathway. Research highlights communication failures and the problems of co-ordination as resulting in delayed, poorly timed and unsafe discharges. The complexity of hospital discharge exemplifies the threats to patient safety found ‘between’ care processes and organisations. In developing this perspective, safe discharge is seen as relying upon enhanced knowledge sharing and collaboration between stakeholders, which can mitigate system complexity and promote safety.AimTo identify interventions and practices that support knowledge sharing and collaboration in the processes of discharge planning and care transition.SettingThe study was undertaken between 2011 and 2013 in two English health-care systems, each comprising an acute health-care provider, community and primary care providers, local authority social services and social care agencies. The study sites were selected to reflect known variations in local population demographics as well as in the size and composition of the care systems. The study compared the experiences of stroke and hip fracture patients as exemplars of acute care with complex discharge pathways.DesignThe study involved in-depth ethnographic research in the two sites. This combined (a) over 180 hours of observations of discharge processes and knowledge-sharing activities in various care settings; (b) focused ‘patient tracking’ to trace and understand discharge activities across the entire patient journey; and (c) qualitative interviews with 169 individuals working in health, social and voluntary care sectors.FindingsThe study reinforces the view of hospital discharge as a complex system involving dynamic and multidirectional patterns of knowledge sharing between multiple groups. The study shows that discharge planning and care transitions develop through a series of linked ‘situations’ or opportunities for knowledge sharing. It also shows variations in these situations, in terms of the range of actors, forms of knowledge shared, and media and resources used, and the wider culture and organisation of discharge. The study also describes the threats to patient safety associated with hospital discharge, as perceived by participants and stakeholders. These related to falls, medicines, infection, clinical procedures, equipment, timing and scheduling of discharge, and communication. Each of these identified risks are analysed and explained with reference to the observed patterns of knowledge sharing to elaborate how variations in knowledge sharing can hinder or promote safe discharge.ConclusionsThe study supports the view of hospital discharge as a complex system involving tightly coupled and interdependent patterns of interaction between multiple health and social care agencies. Knowledge sharing can help to mitigate system complexity through supporting collaboration and co-ordination. The study suggests four areas of change that might enhance knowledge sharing, reduce system complexity and promote safety. First, knowledge brokers in the form of discharge co-ordinators can facilitate knowledge sharing and co-ordination; second, colocation and functional proximity of stakeholders can support knowledge sharing and mutual appreciation and alignment of divergent practices; third, local cultures should prioritise and value collaboration; and finally, organisational resources, procedures and leadership should be aligned to fostering knowledge sharing and collaborative working. These learning points provide insight for future interventions to enhance discharge planning and care transition. Future research might consider the implementation of interviews to mediate system complexity through fostering enhanced knowledge sharing across occupational and organisational boundaries. Research might also consider in more detail the underlying complexity of both health and social care systems and how opportunities for knowledge sharing might be engendered to promote patient safety in other areas.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Hospital Discharge and Patient Safety: Reviews Of The Literamentioning

confidence: 99%

An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge

Waring

Marshall

Bishop

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

show abstract

“…A growing body of international research shows that patients often experience unsafe care before, during and after care transition, often because of the difficulties of coordinating multiple health and social care agencies. [10][11][12][13][14][15] Elaborating this view, this study suggests discharge relies upon a complex network of specialists working within the acute hospital setting, community health and social care, primary care and voluntary sectors. Analysis of the threats to safe discharge therefore requires attention to the interdependencies and interactions between these heterogeneous groups.…”

Section: Main Findingsmentioning

confidence: 99%

“…Common threats to safety are associated with medicines management, the provision of ongoing care, incomplete testing, the use of home adaptation and risks of falls, infections or sores. [11][12][13][14] Analysis of these events consistently identifies communication and coordination across occupational and organizational boundaries as influencing the quality and safety of discharge, especially the accuracy, completeness and timing of interdependent activities. [15][16][17][18] Elaborating these interdependencies, Glasby 19 describes the influence of occupational factors, related to differences in professional knowledge, cultures and practices; organizational factors related to divergent working patterns, capabilities and resources; and compatibility and coordinating factors related to how occupational and organizational differences are aligned.…”

Section: Introductionmentioning

confidence: 99%

Understanding the occupational and organizational boundaries to safe hospital discharge

Waring

Marshall

Bishop

2014

J Health Serv Res Policy

108

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Objective: Safe hospital discharge relies upon communication and coordination across multiple occupational and organizational boundaries. Our aim was to understand how these boundaries can exacerbate health system complexity and represent latent sociocultural threats to safe discharge. Methods: An ethnographic study was conducted in two local health and social care systems (health economies) in England, focusing on two clinical areas: stroke and hip fracture patients. Data collection involved 345 hours of observations and 220 semi-structured interviews with health and social care professionals, patients and their lay carers. Results: Hospital discharge involves a dynamic network of interactions between heterogeneous health and social care actors, each characterized by divergent ways of organizing discharge activities; cultures of collaboration and interaction and understanding of what discharge involves and how it contributes to patient recovery. These interrelated dimensions elaborate the occupational and organisational boundaries that can influence communication and coordination in hospital discharge. Conclusions: Hospital discharge relies upon the coordination of multiple actors working across occupational and organizational boundaries. Attention to the sociocultural boundaries that influence communication and coordination can help inform interventions that might support enhanced discharge safety.

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“…We have previously shown that patients who use ambulation aids prior to hospitalization are at increased risk for decline in walking with hospitalization, and for falls after hospital discharge (13,14). However, the association of assistive device use with loss of ADL independence has not been evaluated.…”

mentioning

confidence: 99%

Use of an Ambulation Assistive Device Predicts Functional Decline Associated With Hospitalization

Mahoney

Sager

Jalaluddin

1999

The Journals of Gerontology Series A: Biological Sciences and M

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Risk of Falls after Hospital Discharge

Abstract: There is a high incidence of falls after hospital discharge, particularly among patients who are functionally dependent. Further study is needed to determine to what extent acute illness and hospitalization may influence falls risk.

Cited by 186 publications

References 44 publications

An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge

An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge

Understanding the occupational and organizational boundaries to safe hospital discharge

Use of an Ambulation Assistive Device Predicts Functional Decline Associated With Hospitalization

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