Hospital Discharge: Practice Issue and Evidence

Practice Issue

The topic

The topic is discharge planning from a hospital.

The nursing practice issue related to the topic

The nursing practice issue associated with the selected topic is discharge planning from a hospital for patients aged 50 and older and its impact on readmission rates.

The scope of the practice issue

The identified nursing practice issue includes prior risk assessment of patients aged 50 and older as well as post-discharge follow-up within 48 hours. The mentioned criteria were identified for a control group to reveal any differences in results compared to those patients that received only discharge instructions.

The practice area

The practice area is clinical.

How the practice issue was identified

  • Safety/risk management concerns
  • Unsatisfactory patient outcomes
  • Significant financial concerns
  • Clinical practice issue is a concern
  • Procedure or process is a time waster

First of all, safety management concerns should be noted as hospital readmission implies the deterioration of patients’ conditions that, in its turn, leads to significant financial losses. While healthcare related costs are required to repeatedly improve patients’ outcomes, the efforts of nurses seem to be insufficient and unsatisfactory. It results in low patient satisfaction and makes discharge procedures a time-waster.

Poor communication between inpatient care specialists and outpatient settings also deteriorates the situation. Since procedures and guidelines may vary across hospitals and specialists, discharge planning becomes a clinical practice concern. Therefore, it is essential to clearly determine the effectiveness of discharge planning and follow-up for older adult patients in acute care compared to a mere provision of instructions.

Evidence that must be gathered

  • Literature search
  • Guidelines
  • Expert Opinion
  • Patient Preferences
  • Financial Analysis
  • Standards (Regulatory, professional, community)

The literature search, patient preferences, guidelines, standards, expert opinion, and financial analysis seem to be essential to properly evaluate the role of discharge planning and follow-up in reducing hospital readmission rates. The inclusion of all of the mentioned evidence sources would allow assessing different angles of the identified health problem and providing comprehensive results.

Evidence Summary

The practice problem with reference to the identified population, setting and magnitude of the problem in measurable terms

Discharge planning of adults aged 50 and older from acute care settings is a serious problem that incurs additional healthcare losses, leads to unsatisfactory patient outcomes, and causes hospital readmission.

The objectives of the related systematic review article

The systematic review by Gonçalves‐Bradley, Lannin, Clemson, Cameron, and Shepperd (2016) aims at reviewing and assessing the role of hospital discharge planning based on 20 trials, focusing on older adult patients. In particular, the authors targeted the evaluation of personalized discharge plans for patients.

A statement of the questions being addressed in the work and relation to the practice issue

The following questions may be identified in the study conducted by Gonçalves‐Bradley et al. (2016): Whether discharge planning reduces readmission rates or not?; Is it possible to improve patient health outcomes and satisfaction by means of discharge planning and follow-up? Can hospital discharge planning reduce healthcare costs? These questions directly relate to the topic selected as the answers would allow understanding how this current clinical practice concern may be addressed.

The summary of the interventions the authors suggest to improve patient outcomes

The interventions assumed by the authors of the identified systematic review include the elaboration of individualized discharge plans for patients who leave an acute care setting (Gonçalves‐Bradley et al., 2016). In some cases, post-discharge support was involved in the intervention, or it was used as part of geriatric care.

The summary of the main findings by the authors of your systematic review including the strength of evidence for each main outcome

The first main finding discovered by Gonçalves‐Bradley et al. (2016) is that discharge planning may reduce hospital length stay: 12 studies showed -0.73 [-1.33, -0.12] reduction, and other 11 studies – -0.98 [-1.57, -0.38]. The above finding can be determined as a moderate Overall Strength of Evidence (SoE) since all reviews were consistent, and estimates were precise. The second finding is that discharge planning seems to allow slightly reducing readmission rates within three months (17 studies, effect size is 0.88 [0.79, 0.97]).

The strength of the above evidence can be regarded as very low certainty evidence due to insufficient data. The third key finding is associated with the fact that hospital discharge planning may increase patient satisfaction and that of health care workers ((low certainty evidence – only six trials).

The supplementary article findings relate to the prevalence of hospital readmissions, approaches to reduce them, and methods to perform risk assessment (Kripalani, Theobald, Anctil, & Vasilevskis, 2014). The authors detected that compared to individual interventions multifaceted initiatives are more effective. The key features of successful planning included the alignment of inpatient and outpatient care and the engagement of an interprofessional care team. The level of evidence may be identified as moderate due to II level of the baseline sources.

Evidence-based solutions for the project

One of the most important evidence-based solutions that should be integrated into the project is comprehensive discharge plans for patients. It is essential to involve several specialists to ensure proper transition of a patient from acute care settings to outpatient services and self-management. The inclusion of an interprofessional team would ensure communication between professionals and shared decision-making. At the same time, patients should be equipped with relevant information and instructions regarding their conditions. The post-discharge monitoring should also be implemented to control patients’ health outcomes, thus reducing hospital readmission rates and increasing patient satisfaction levels.

Limitations to the studies

Data interpretation in the identified studies may be considered the main limitation that may affect its utilization in the project. Since the authors of both studies measured outcomes in their heterogeneity, it is possible to note the mixed nature of evidence. In addition, the level of evidence of some findings is low that may show their poor effectiveness in impacting hospital readmission rates. Nevertheless, these limitations may serve as the basis for further research by outlining the needs to be addressed.

References

Gonçalves‐Bradley, D. C., Lannin, N. A., Clemson, L. M., Cameron, I. D., & Shepperd, S. (2016). Discharge planning from hospital. The Cochrane Library, 1, 1-72.

Kripalani, S., Theobald, C. N., Anctil, B., & Vasilevskis, E. E. (2014). Reducing hospital readmission rates: Current strategies and future directions. Annual Review of Medicine, 65, 471-485.