Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives

Kate Gledhill; Tracey K Bucknall; Natasha A Lannin; Lisa Hanna

doi:10.1186/s12913-023-09285-y

Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives

BMC Health Serv Res. 2023 May 2;23(1):425. doi: 10.1186/s12913-023-09285-y.

Authors

Kate Gledhill^{1

2

3}, Tracey K Bucknall^{4

5

6}, Natasha A Lannin^{7

5}, Lisa Hanna^{8

9}

Affiliations

¹ School of Health and Social Development, Deakin University, Geelong, Australia. kate.gledhill@monash.edu.
² School of Primary and Allied Healthcare, Monash University, Frankston, Australia. kate.gledhill@monash.edu.
³ Department of Occupational Therapy, School of Primary Health and Allied Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, VIC, 3199, Australia. kate.gledhill@monash.edu.
⁴ School of Nursing and Midwifery, Deakin University, Melbourne, Australia.
⁵ Alfred Health, Melbourne, Australia.
⁶ Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Australia.
⁷ Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
⁸ School of Health and Social Development, Deakin University, Geelong, Australia.
⁹ Institute of Health Transformation, Deakin University, Geelong, Australia.

Abstract

Background: Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient's readiness for discharge places a heavy reliance on a clinician's judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians' perspectives and in the acute care setting. This paper aimed to explore the perceptions of discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers.

Methods: A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audio-recorded. Following transcription, inductive thematic analysis was completed.

Results: Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors).

Conclusions: These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients' discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention.

Keywords: Clinical decision-making; Length of stay; Patient discharge; Patient readmission; Qualitative; Sub-acute Care.

MeSH terms

Focus Groups
Humans
Inpatients
Patient Discharge*
Qualitative Research
Subacute Care*