Table 3 Functional performance and outcome variability in hospital discharge of elderly patients
Functions | Variability in discharge practices | Variability in outcome | |
|---|---|---|---|
| Â | Time and duration | Precision | Â |
Review of hospital inpatients—classifying patients that are medically fit for discharge. | Time of day when the decision was determined. | Criteria upon which the decision was established and degree of knowledge sharing with the care team. | Time of day the patient was determined medically fit (i.e., duration of the discharge process) Patient’s degree of readiness Receiving health-care provider’s degree of satisfaction with the decision about medical fitness. |
Notifying the municipality that the patient is medically fit. | Time of day when the municipality was notified. | Degree of compliance with cooperation agreements. | Duration of the discharge process (i.e., delay in the discharge process in the case of non-compliance). |
Informing the patient that they are ready for discharge. | Time of day the patient was informed and time allotted to each patient. | Approaches concerning content or type of information provided, the language used, and how the patient was approached. | Patient involvement in the discharge planning process and degree of satisfaction. |
Assigning an appropriate post-discharge site of care and notifying the hospital. | Time of day the hospital was notified | Criteria for prioritizing patients for post-discharge care. | Duration (i.e., number of additional days spent after being determined medically fit). Level of post-discharge care offered. Degree of satisfaction concerning post-discharge arrangements. |
Notifying and informing the patient’s next of kin (if any). | Time of day relatives were informed and time spent. | Degree of information provided and by whom (level of competence, doctor or nurse). | Next of kin’s degree of satisfaction and perceived involvement in the discharge planning process. |
Preparing a nursing discharge record. | Time of day the record was prepared and time available (time spent). | Prevalence and quality of the contents. | Quality of the information transfer Receiving health-care provider’s degree of satisfaction. |
Preparing a medical discharge letter. | Time of day the letter was prepared and time available (time spent). | Quality of the contents, structure, and readability. | Quality of the information transfer Receiving health-care provider’s degree of satisfaction. |
Providing oral information about the transfer to post-discharge care providers. | Time of day and time spent. | Degree and quality of the information provided and by whom (level of competence). | Receiving health-care provider’s degree of satisfaction. |
Ordering transportation. | Time/hour arranged for transfer. | The choice of arrangements and transportation (taxi, ambulance, next of kin) and the dialogue between the doctor and nurse. | The responsible doctor’s involvement in the decision concerning the time for transfer—affected degree of time pressure to prepare the medical discharge letter. |
Transferring the patient to the post-discharge site of care and ensuring the transfer of written information. | Time of day the patient was transferred. | Degree of compliance with arrangements. Unpredictable if carried out by the ambulance service (owing to simultaneous responsibilities). | Time of day the patient arrived in primary care and the receiving health-care provider’s degree of satisfaction with the time of arrival. |