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Hospital Discharge Stage 2

Improving the hospital discharge process to minimize patient readmission: a partnership with consumers.

This proposal is based upon findings of pilot work for improving patient discharge processes undertaken in 2017 in the Acute Medical Unit1.

The 50 observed discharges recorded waiting times of 209 mins (median) due to delays in paperwork/prescriptions, availability of medical staff or competing service delivery demands. Of the 43 patients followed up at 1 week, 7 (16%) had been readmitted. Patients reported lack of clarity about their hospitalisation, expectations for self-care, and frustration with delays. Nurses reported being uncertain if patients understood discharge information/expectations, and that constant, competing demands led to rushed discharge conversations.

The aim of this research is to refine and trial innovative processes to prepare patients for discharge including a focused final conversation to ensure understanding and clarity for self-management at home.

This has been shown to improve self-management and decrease readmissions.
This will be achieved through –

• Enabling in-patients, with family, to formulate ‘questions for my team’ about current treatments and expectations upon discharge.

• Incorporating strategies such as ‘teach-back’ to gauge patients’ understanding of self-management requirements; simplify information exchange by creating ‘5 most important points’ to guide discussions

• Assessing new interventions using 50 observed patient discharges

• Following-up patients at 1 and 6 weeks to determine readmission/satisfaction/coping

• Using Focus groups/short surveys of health professionals and patients to determine impact/effectiveness of interventions

• Ensuring health literacy and patient centredness are central to methodology

1. Foundation for Nursing Research 2017– Hahn, Kelly, Leslie & Brearley.