Informing Discharge Plans. Assessments of Elderly Patients in Australian Public Hospitals: A Field Study

A Peer Reviewed Publication of the College of Allied Health & Nursing at Nova Southeastern University Dedicated to allied health professional practice and education http://ijahsp.nova.edu Vol. 2 No. 3 ISSN 1540-580X Informing Discharge Plans - Assessments of Elderly Patients in Australian Public Hospitals: A Field Study Karen Grimmer, Ph.D.1 Esther May, Ph.D.2 Anna Dawson, B.AppSci Physio3 Claudia Peoples, B.SocWk4 1. 2. 3. 4. Associate Professor , Centre for Allied Health Evidence, Division of Health Sciences, University of South Australia Division of Health Sciences, University of South Australia Division of Health Sciences, University of South Australia Division of Health Sciences, University of South Australia Citation: Grimmer, K. May, E., Dawson, A., Peoples, C. Informing Discharge Plans. Assessments of Elderly Patients in Australian Public Hospitals: A Field Study. The Internet Journal of Allied Health Sciences and Practice. July 2004. Volume 2 Number 3. Abstract This paper describes assessment practices related to discharging elderly patients from Australian acute public hospitals. Common assessments were of cognition, continence, wound care, hygiene needs, nutrition, mobility and self-care. Nurses and social workers commonly took non-standardised assessment approaches, whilst therapists were more likely to use published assessment instruments. Patients’ perspectives were rarely incorporated into assessments. The relationship between many common assessment items and patients’ ability to manage safely after discharge from hospital was unclear. The validity of assessment items, the reliability with which assessments were taken, ‘normal’ variability in responses, and interpretation of instrument ‘scores’ with respect to post-discharge independence were rarely considered.This study highlighted the need to consider organisational and professional barriers to good discharge planning practices, the purpose, frequency, validity and accuracy of discharge-related assessments, patients’ and carers concerns, health professionals’ capacity, opportunity and commitment to share assessment findings relative to planning discharge. INTRODUCTION Discharge planning research consistently reports the importance of taking elderly patients’ complex and multifactorial health problems into account when planning their discharge from hospital.1,2 It is increasingly common for an elderly person to be discharged ‘early’ from hospital, consequently requiring family and community supports to assist in their recuperation. 3,4 Discharge planning is the process by which the required support services are organised to address short-term deficits in patients’ health and functional status on discharge from hospital.1-5 These deficits are identified by assessing patients’ current health and functional status, compared with that required for independent community living.6 Identifying and addressing these deficits is a major challenge of discharge planning.7-10 Failure to do this can result in unplanned re-admissions of often, very ill elderly people to acute hospital beds, increased load on patients and families, increased unplanned and unnecessary use of community support services, compromised health and social functioning of older people in the community and/or earlier than planned admission to residential care.11 © The Internet Journal of Allied Health Sciences and Practice, 2004 Informing Discharge Plans - Assessments of Elderly Patients in Australian Public Hospitals: A Field Study 2 While there is little research into the nature, amount and frequency of assessment data required to form discharge plans, there are concerns worldwide about the volume of assessment data collected from elderly patients whilst they are in hospital, and inefficiencies in data collection, storage, retrieval and synthesis.12-15 To effectively and efficiently plan the discharge of elderly patients from a hospital requires a recognition by hospital staff of the minimum number of critical assessment items for each patient, measured at appropriate time intervals.16 This paper reports on an investigation into discharge planning-related assessments of elderly patients in Australian public hospitals. This study was undertaken under the direction of a standing committee of the Australian Health Ministers Advisory Council (called our Reference Committee). For the purpose of this study the definition of the term ‘assessment’ (relative to discharge planning) as proposed by the Department of Health, UK6 was used (‘a collection of scales, questions and other information to provide a rounded picture of an individual’s needs and related circumstances’). METHOD Ethics approvals The study was approved by the relevant ethics committees of the researchers’ university and all participating hospitals. Study Design A cross-sectional observational study captured information on assessment practices in Australian acute public hospitals, related to planning discharge for elderly patients. Data collection Invitations to participate in the study were sent to 24 acute public hospitals, identified by the Reference Committee as representative of Australian hospital location (rural and remote, capital city, other large cities)17 and bed size (<100 beds, 100300 beds, 300-500 beds, 500+ beds). Each hospital administrator assigned a key hospital contact who was integrally involved in planning discharge for older patients. This contact then identified all other relevant hospital staff engaged in some way with this activity. Questionnaires seeking information on discharge-related assessment processes were sent to all assigned staff contacts, including requests for all relevant assessment documentation. Themes covered by the questionnaires comprised: · · · · · Organisational service models and referral practices Role of specific health disciplines in assessment and discharge planning Assessment tools Systems and procedures related to documentation, retrieval and communication of assessment findings Barriers to and facilitators of effective assessment related to discharge planning practices Site visits were then undertaken, where key personnel participated in semi-structured interviews with the researchers to expand on the questionnaire responses. An iterative approach18 underpinned all interviews, based on the notion that when no new information was forthcoming, a complete picture had been provided of the discharge-related assessment practices at the hospital. Data analysis Site maps of each hospital, and data summary tables were constructed to outline the referral processes for discharge assessments. This included the staff involved in these assessments, how assessments were documented, retrieved, analysed and communicated (within hospital, and between hospital and community), and how assessments were related to discharge plans. Comparisons were then made within, and between, strata of hospital location and bed size. RESULTS AND DISCUSSION Hospit (...truncated)