Risks with older adults in acute care settings: UK occupational therapists’ and physiotherapists’ perceptions of risks associated with discharge and professional practice

Abstract

Internationally, there is evidence that hospital discharge to home for older adults is a complex and challenging process that is dependent upon multidisciplinary team working. At the centre of the discharge process is the management of risk, which involves occupational therapists and other healthcare professionals managing perceived dangers and determining why some dangers are seen as presenting risks while others are not. This study did not aim to explore interprofessional differences but to ascertain a greater understanding of professionals' perceptions of risk in acute care settings. This qualitative study utilised 12 semi-structured interviews with seven occupational therapists and five physiotherapists in the United Kingdom (UK). During the interview, therapists were asked to read and answer questions on a validated vignette. The interview data were subjected to thematic content analysis and the vignettes to template analysis. Our research is one of the first studies to explore therapists' perceptions of risk with older adults in acute care settings. Our study has highlighted that perception of risk does have an impact on discharge decision-making and location. Therapists used negative terminology to refer to patients who wanted to take risks, which could be a reflection of the therapists' anxiety. Mental capacity, and patients' functioning and safety were key factors in risk decision-making with older adults. Our research has highlighted the potential value of multidisciplinary working to manage risk situations and the need for reflection and discussion regarding how persons who do not have capacity wishes are managed within acute care settings. There is a need to develop an interprofessional care pathway to guide clinicians through the risk decision-making process which needs to ensure that the client's opinions and wishes are taken into account throughout.

Occupational therapy practice in acute physical hospital settings: Evidence from a scoping review

“…Three articles detailing the nature of practice in acute care identified that therapists felt their practices were predominantly defined by their ability to provide a safe and timely discharge home for patients (Blaga & Robertson, 2008;Craig et al, 2004;Griffin & McConnell, 2001). To facilitate this, therapists often completed or referred for a home assessment to identify risks, observe client function and make safety recommendations (Atwal, McIntyre & Wiggett, 2012;Crennan & MacRae, 2010). Concepts of risk and acceptable levels of discharge risk were researched by Atwal, Wiggett & McIntyre, (2011).…”

Patient decision making in the face of conflicting medication information

“…In the qualitative paradigm, vignettes are used for different purposes, one of which is to allow for situational context (Hazel, 1995) and are invaluable as a research tool when respondents have not had (or cannot remember) their own personal experience with the issue or situation at hand (Reynold, 2002). Vignettes are commonly used as a way to explore individuals’ decision making strategies among patients (Anthony, 2007; Swenson, Zettler, & Lo, 2006; Vellinga, Smith, Van Leeuwen, Van Tilburg, & Jonker, 2005) and their providers (Anderson, Fuller, & Dudley, 2007; Atwal, McIntyre, & Wiggett, 2012; Long-Sutehall et al, 2011; Sweeney & Doody, 2010). …”

New care home admission following hospitalisation: How do older people, families and professionals make decisions about discharge destination? A case study narrative analysis

“…Differing understandings of risk between professionals, patients and family carers are well established (Clarke, 2000;Clarke, Wilkinson, Gibb, Luce, & Williams, 2010;Mitchell & Glendinning, 2007) and these colliding perspectives shape planning for care home admission. Risk assessment and management are understood to be central to professional practice in healthcare (Alaszewski, Harrison, & Manthorpe, 1998;Manthorpe, Walsh, Alaszewski, & Harrison, 1995) and are influential determinants of decision-making, specifically influencing discharge destination (Atwal, McIntyre, & Wiggett, 2012).…”