Practice Issue
What practice issue has been identified related to the chosen topic?
The practice issue in question is the high morbidity among the patients with respiratory conditions. Elderly patients are the population that is especially vulnerable to the identified issue due to higher relevance of emotional and physical well-being for the treatment process (Naylor et al., 2016). In addition, the selected topic is associated with several undesirable effects, specifically the increased likelihood of readmission in the future.
What is the scope of the practice issue?
The issue of discharge planning presents a challenge for healthcare professionals of different countries, including both the developed and developing ones. The latter experience the majority of the adverse effects, chiefly in the area of patient outcomes, with increased mortality rate being the most apparent example. Nevertheless, the financial restrictions make it an equally pressing concern for the former.
What is the practice area?
Clinical
How was the practice issue identified?
- Unsatisfactory patient outcomes
- Wide variations in practice
- Significant financial concerns
What is the rationale for the checked selections?
The most apparent aspect of the issue is its association with negative patient outcomes. The patients who receive no consistent discharge planning are at a higher risk of readmission within 30 days. In addition, on at least some occasions the length of hospital stay is longer for patients with no education incorporated into a discharge plan. Next, wide variations in practice are to be expected due to the lack of a universal standard on the inclusion of education in the discharge planning process. Finally, an appropriate, education-backed discharge plan is expected to decrease admission charges, which is especially important for patients and healthcare providers in the developing countries, as well as any setting where the financial concerns pose a significant limitation to the delivery of health care.
What evidence must be gathered?
- Literature search
- Guidelines
What is the rationale for the checked selections?
The most apparent source of evidence can be gathered using literature search. The reason for it is the high specificity of the evidence in question. Since both the necessity and the effectiveness of discharge planning is already a fairly established clinical practice, it is important to focus on a specific correlation between the personalized education included in the discharge plan and the rate of readmission of the patients. The evidence of such a correlation can only be considered reliable when it is based on data from studies with sufficient sample size. It is also possible to incorporate guidelines that are typically based on evidence from such studies. However, due to high specificity of the inquiry, the latter will likely be of insufficient precision for the purpose of the project.
Evidence Summary
The practice problem with reference to the identified population, setting and magnitude of the problem in measurable terms
Discharge planning is a practice of developing guidelines for the patient intended to improve patient outcomes and minimize health care expenses. While patient education is normally an integral part of a discharge plan and is generally considered beneficial for the patient, there is insufficient data for the viability of such a modification. Arguably, the effect is especially apparent in elderly patients due to deteriorating mental and physiological health. The issue can be observed in a healthcare setting of both developed and developing countries.
Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness
The objectives of the article
The study proposed in the article is expected to assess the effectiveness of a specific type of discharge plans, which are assigned individually by a caseworker on admission, in the process of repeated hospitalization associated with chronic lung diseases (Hall, Chang, & O’Grady, 2016). The effectiveness is determined through a comparison with a control group – a population segment who receive standardized discharge plans not developed by a caseworker.
A statement of the questions being addressed in the work
The question addressed in the paper is whether a discharge plan that is developed individually results in better patient outcomes. The improvement is expected to occur as a result of improved communication between patients and healthcare providers, better information on the inpatient and outpatient services provided in the area, better coordination of care after the discharge, and promotion of healthy lifestyle. While only the latter is explicitly tied to patient education by the authors of the article, it is reasonable to connect the remaining points to it. Thus, the study is indirectly relevant to the practice issue.
The interventions the authors suggest to improve patient outcomes
The intervention suggested by the authors is based on the involvement of a caseworker assigned to a patient at admission. The caseworker is expected to adjust the standard plan in a way that will acknowledge the patients’ individual needs and involve both the patients and their families in the treatment process through support, motivation, and behavior risk modification. Such approach to discharge planning is aimed at addressing gaps in the standardized hospital and self-management discharge plans.
The main findings by the authors of the systematic review including the strength of evidence for each main outcome
The selected article is a protocol for review and, therefore, does not contain findings of the study. Nevertheless, according to a research hypothesis, it is reasonable to expect caseworker-developed discharge plans to prevent hospitalizations associated with chronic lung disease. By extension, these findings could be applied to the project that uses 30-day readmissions as a dependent variable.
Evidence-based solutions to be considered for the project
In the case of the hypothesis being confirmed, the solution in question is the involvement of specific caseworkers in the process of a discharge plan at the stage of patient admission.
Limitations to the studies performed that impact the ability to utilize the research in the project
First, the article in question studies the effects of discharge plans on children, making the results only indirectly compatible with the goals of the project. Second, it incorporates a much broader focus, including education as one of several characteristics of the planned intervention. Such an approach introduces several uncontrolled independent variables, decreasing the applicability of the results.
References
Hall, K. K., Chang, A. B., & O’Grady, K. F. (2016). Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness. The Cochrane Library, 8. Web.
Naylor, M. D., Hirschman, K. B., Hanlon, A. L., Bowles, K. H., Bradway, C., McCauley, K. M., & Pauly, M. V. (2016). Effects of alternative interventions among hospitalized, cognitively impaired older adults. Journal of Comparative Effectiveness Research, 5(3), 259-272.