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JBI Evidence Synthesis podcasts: special issue on discharge planning

Creator: Marianne E. Weiss, DNSc, RN
Duration: 8:05
JBI Evidence Synthesis February 2020, Volume 18, Issue 2;

Marianne E. Weiss, DNSc, RN

Professor Emerita of Nursing, Marquette University, Milwaukee, USA

In a recent Cochrane review, Goncalves-Bradly et al.1 described discharge planning as the development of a personalized plan for each patient who is leaving hospital, with the aim of containing costs and improving patient outcomes. Discharge planning should ensure that patients leave hospital at an appropriate time in their care and that, with adequate notice, the provision of post-discharge services will be organized. Yet, discharge planning is only effective if the plan is successfully operationalized.

Discharge planning is the critical thinking and decision step. It requires making decisions regarding two  areas related to the primary goals of discharge planning, which are to promote timely discharge and to reduce risk of readmission due to post-discharge adverse complications or events. The first decision involves identifying the patient’s needs for post-discharge care, and including special needs for discharge coordination and teaching. The second decision concerns identifying the patients who are at risk for post-discharge problems and deciding what transitional care support is needed to prevent return to the hospital.

Effectiveness of discharge planning is difficult to evaluate because it depends on the activation of planned transitional care services and effective discharge teaching of the patient and family. Discharge planning is not an isolated activity but rather the initiating plan for a personalized set of care coordination and patient/family teaching interventions carried out by multiple members of the health team. As such, measuring the effectiveness of discharge planning must consider the configuration of roles and interventions for their relative contribution to patient outcomes. Clinical trials are needed that clearly specify the model of discharge preparation, including the components of discharge planning, coordination and teaching, so that the contribution of each component to patient outcomes can be effectively differentiated.

Reference

1. Gonçalves-Bradley DC, Lannin NA, Clemson LM, Cameron ID, Shepperd S. Discharge planning from hospital. Cochrane Database Syst Rev. 2016;(1):CD000313.
Creator: Kathryn H. Bowles, PhD, RN, FAAN, FACMI
Duration: 8:17
JBI Evidence Synthesis February 2020, Volume 18, Issue 2;

Kathryn H. Bowles, PhD, RN, FAAN, FACMI 

Professor of Nursing and van Ameringen Chair in Nursing Excellence, University of Pennsylvania School of Nursing, and Director of the Center for Home Care Policy and Research at the Visiting Nurse Service of New York

Promoting best practice in discharge following sedation for endoscopic procedures is important for patient safety and well-being, in addition to ensuring patients are not held up by system delays or other issues. Sedation in particular leads to an increased risk of significant events such as cardiac arrest or death, and although rare, these events are 10 times higher when sedation includes propofol. Discharge planning is a critical function, but without specific evaluation, it may not be evidence-based. To optimize discharge planning, a thorough evaluation of current practice against best practice is needed, particularly in clinics with high patient flow, such as the endoscopy clinic where this implementation project was conducted.1

This endoscopy clinic project identified a series of best practice recommendations from JBI evidence, then conducted an audit and feedback project over six months using two key software tools: Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) matrix. PACES supported the baseline audit and found gaps in best practice, and then the multidisciplinary team used GRiP to evaluate barriers and facilitators and to identify the resources needed to improve practice. These methods can be applied to any complex process. The key messages of this podcast include: use a team-based approach, incorporate tools that assist with reflection (such as JBI PACES and GRiP), conduct follow-up evaluations and assessments to measure improvement, and consider areas for future follow-up.

It is important to systematically evaluate your processes, and to set goals for measuring outcomes and determining your successes. Implementation mapping is a useful adjunctive process to audit and feedback to achieve these goals.2

References

1. Cai X, McArthur A. Discharge following sedation for endoscopic procedures: a best practice implementation project. JBI Evid Synth. 2020;18(2):348-56.

2. Fernandez ME, ten Hoor GA, van Lieshout S, Rodriguez Sa, Beidas RS, Parcel G, et al. Implementation mapping: using intervention mapping to develop implementation strategies. Front Public Health. 2019;7:158.