Table 3 Descriptive statistics of round one rating (36 statements)
From: Framework and components for effective discharge planning system: a delphi methodology
Clarity* | Validity* | Applicability* | Remark | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Median | IQR | Mean | SD | Median | IQR | Mean | SD | Median | IQR | Mean | SD | ||
Theme 1: Initial screening | |||||||||||||
1a. An initial risk screening should be performed within 24 h after admission to identify those patients with high risk of admission and have complex discharge planning, required to provide ongoing care and additional support after leaving hospital. | 4.00 | 1.00 | 4.33 | 0.70 | 4.00 | 0.00 | 3.96 | 0.75 | 3.00 | 1.00 | 3.38 | 0.71 | Discussion 1 (applicability issue) |
1b. HARRPE (Hospital Admissions Risk Reduction Program for the elderly), a screening tool developed by HA, could be used to stratify those elderly aged 60 or above with a higher risk of hospital readmission. | 4.00 | 1.00 | 4.33 | 0.57 | 4.00 | 1.00 | 3.83 | 0.82 | 4.00 | 0.00 | 3.96 | 0.62 | Discussion 2 (validity issue) |
1c. A patient with score of above 0.2 is considered as high risk and requires a complex discharge arrangement. | 4.00 | 1.00 | 4.43 | 0.59 | 4.00 | 1.00 | 4.17 | 0.58 | 4.00 | 0.00 | 4.13 | 0.46 | |
The following items should be included in the initial assessment for all patients to serve as flags to trigger discharge planning as appropriate: | |||||||||||||
1d. Social support – living alone, day time alone, night time alone, with maid, with spouse, with children, with grandchildren, with others. | 4.5 | 1 | 4.08 | 1.21 | 4 | 1 | 4.17 | 0.82 | 4 | 1 | 4.29 | 0.69 | |
1e. Care support – Yes (by spouse, son, daughter-in-law, daughter, son-in-law, grandchildren, maid, others), No | 4 | 1.75 | 4.08 | 1.06 | 4 | 1 | 4.25 | 0.68 | 4 | 1 | 4.25 | 0.79 | |
1f. Any change of ADL: ADL Barthel Index before admission, and on admission (declining ADL index) | 4 | 1 | 4.21 | 0.72 | 4 | 1 | 4.08 | 0.88 | 4 | 1 | 3.71 | 1.08 | Discussion 3 (applicability issue) |
1g. Functional ambulatory category (modified): lyer, sitter, dependent walker, assisted walker, supervised walker, indoor walker, outdoor walker (independent, assisted with carer, assisted with equipment) | 4 | 1 | 4.21 | 0.66 | 4 | 1 | 4.25 | 0.79 | 4 | 1 | 4.25 | 0.90 | |
1h. History of fall risk for the past one year: No history of fall, history of fall = 1, recurrent falls, present to medical attention for fall, both risk factors are present | 4 | 1.75 | 4.00 | 0.93 | 4 | 0.75 | 4.21 | 0.51 | 4 | 0 | 4.13 | 0.54 | |
1i. Mental state: normal, disorientated, disturbed, poor memory, not communicate | 4 | 1.75 | 4.00 | 0.93 | 4 | 1 | 4.25 | 0.53 | 4 | 0.75 | 4.00 | 0.78 | |
1j. Medications: good drug compliance, poor drug compliance | 4 | 1.75 | 4.13 | 0.90 | 4 | 1 | 4.33 | 0.57 | 4 | 0.75 | 4.04 | 0.69 | |
Theme 2: Discharge planning process | |||||||||||||
2a. The four main dimensions for assessment should include medical health, physical, psychological and social functioning. | 5 | 1 | 4.63 | 0.50 | 5 | 1 | 4.58 | 0.50 | 4 | 1 | 4.21 | 0.66 | |
2b. Care plan should be performed within 24 h after admission. | 5 | 1 | 4.46 | 0.66 | 4 | 1 | 3.83 | 0.87 | 3 | 1 | 3.08 | 0.72 | Discussion 4 (validity & applicability issue) |
2c. Three categories of discharge plans could be developed based on the complexity of patients and assessment of their needs: | 4 | 1 | 4.41 | 0.59 | 4 | 1 | 4.32 | 0.48 | 4 | 0 | 4.00 | 0.44 | |
● Generic discharge plan suitable for simple cases | |||||||||||||
●Disease-based discharge plan suitable for complex cases when there are disease specific protocols | |||||||||||||
●Non-disease specific, but tailored, discharge plan for complex cases identifying either by HARRPE or by assessment | |||||||||||||
2d. Ongoing assessment/evaluation should be conducted throughout the episode of care to review and update the conditions of patients. | 5 | 1 | 4.70 | 0.47 | 5 | 1 | 4.61 | 0.50 | 4 | 0 | 3.96 | 0.64 | |
2e. Systems for the accurate and timely communication of assessment and associated care planning information across clinical disciplines and settings should be developed and implemented to enhance care continuity. | 4 | 1 | 4.29 | 0.69 | 4.5 | 1 | 4.50 | 0.51 | 4 | 1 | 3.79 | 0.59 | Discussion 5 (applicability issue) |
Theme 3: Coordination of discharge | |||||||||||||
3a. A designated person e.g. a designated doctor, nurse, or allied health professional should be notionally responsible for ensuring that all aspects of discharge planning have been addressed by the time of discharge. | 5 | 1 | 4.54 | 0.51 | 5 | 1 | 4.50 | 0.59 | 4 | 0 | 3.88 | 0.54 | |
3b. Once the patient is identified to have complex care needs, the designated person should initiate discharge planning with a multidisciplinary approach. | 4.5 | 1 | 4.46 | 0.59 | 4 | 1 | 4.33 | 0.64 | 4 | 0 | 4.00 | 0.59 | |
3c. Case conference should be considered for high risk patients for better communication between team members in the multidisciplinary team and to enable seamless and timely transition from hospital to community. | 5 | 1 | 4.46 | 0.72 | 4 | 1 | 4.29 | 0.75 | 4 | 1.75 | 3.96 | 0.75 | Discussion 6 (applicability issue) |
3d. The suitability of discharge destination e.g. whether home or old-aged home should be assessed to ascertain whether the support required is available. | 4 | 1 | 4.25 | 0.74 | 4 | 1 | 4.25 | 0.61 | 4 | 0 | 3.88 | 0.54 | |
3e. Referral/arrangement for social support services should be initiated once the patient is assessed to have post discharge support need in the community. | 5 | 1 | 4.42 | 0.78 | 5 | 1 | 4.50 | 0.59 | 4 | 0 | 3.88 | 0.80 | |
3f. Formal mechanisms for information transfer across clinical and social settings e.g. through discharge summary should be adopted rather than solely relying on informal communication between health and social professionals. | 4 | 1 | 4.29 | 0.91 | 4 | 1 | 4.25 | 0.74 | 4 | 1 | 3.75 | 0.74 | Discussion 7 (applicability issue) |
3g. Prompt provision of all community equipment including walking aids, wheelchairs, low vision or hearing aids, safety alarm, urinal, blood pressure machines, glucometers, visual door etc. should be ensured before discharge. | 4.5 | 1 | 4.38 | 0.71 | 4 | 1 | 4.04 | 0.86 | 3 | 1 | 3.54 | 0.88 | Discussion 8 (applicability issue) |
3h. Appropriate education and training should be provided to patients/carers to ensure that they understand how to use the equipment. | 5 | 1 | 4.5 | 0.66 | 4 | 1 | 4.42 | 0.58 | 4 | 0 | 4.13 | 0.54 | |
3i. Appropriate information and education on medication management including side effects of medication should be provided to patients/carers before discharge. | 5 | 1 | 4.54 | 0.51 | 5 | 1 | 4.54 | 0.51 | 4 | 0 | 4.04 | 0.62 | |
Theme 4: Implementation of discharge | |||||||||||||
4a. Patients and/or carers should be engaged in the preparation of the discharge process. | 5 | 1 | 4.71 | 0.46 | 5 | 1 | 4.67 | 0.48 | 4 | 0 | 3.92 | 0.65 | |
4b. Appropriate information on their illness should be given to the patients/carers to ensure that they could manage their ongoing care after discharge. | 5 | 1 | 4.58 | 0.58 | 4.5 | 1 | 4.46 | 0.59 | 4 | 0 | 4.08 | 0.50 | |
4c. Patients/carers should be informed of any danger signals they should be aware of before discharge. | 5 | 1 | 4.63 | 0.58 | 5 | 1 | 4.54 | 0.59 | 4 | 0 | 4.13 | 0.54 | |
4d. A patient copy of discharge summary and/or nursing discharge summary should be given to patients/carers on the date of discharge. | 5 | 1 | 4.54 | 0.51 | 4 | 1 | 4.13 | 0.68 | 4 | 1 | 3.5 | 0.79 | Discussion 9 (applicability issue) |
4e. If the patient has complex care needs/disease specific problem, a contact information should be provided on who to contact if they are concerned about their condition or treatment after discharge. | 4 | 1 | 4.38 | 0.71 | 4 | 1 | 4.38 | 0.58 | 4 | 0.75 | 3.88 | 0.74 | |
4f. Discharge summaries with necessary information should be issued to the facilities or care providers e.g. old aged homes within 48 h of discharge. | 4.5 | 1 | 4.42 | 0.65 | 4 | 1 | 4.17 | 0.87 | 4 | 0.75 | 3.92 | 0.78 | |
4g. Discharge summaries with necessary information should be issued to the Hospital Authority outpatient and day care services within a week of discharge. | 4.5 | 1 | 4.38 | 0.77 | 4 | 1 | 4.21 | 0.88 | 4 | 1 | 4.08 | 0.88 | |
4h. When transport is to be used, this should be booked at least 24 h, where feasible, in advance of discharge. | 5 | 1 | 4.46 | 0.72 | 4 | 1 | 4.33 | 0.70 | 4 | 1 | 3.75 | 0.85 | Discussion 10 (applicability issue) |
4i. Timely transport arrangements when attending outpatient appointments should be made if necessary. | 4 | 1 | 4.29 | 0.86 | 4 | 1 | 4.21 | 0.72 | 4 | 0.75 | 3.79 | 0.78 | |
4j. A “Patient Checklist” should be completed by the patient or carers before discharge to ensure that they understand the discharge plan and their needs are addressed. | 4 | 1 | 4.46 | 0.51 | 4 | 0.75 | 4.17 | 0.57 | 4 | 1 | 3.5 | 0.93 | Discussion 11 (applicability issue) |
Theme 5: Post discharge follow up | |||||||||||||
5a. If the patient has complex care needs and is transferred from an acute hospital to a rehabilitation hospital, verbal communication via telephone or written information about the patient’s conditions should be made between the healthcare professionals in acute and rehabilitation hospitals. | 5 | 1 | 4.46 | 0.78 | 4.5 | 1 | 4.46 | 0.59 | 4 | 1 | 4.25 | 0.68 | |
5b. If the patient is referred to disease specific or special discharge programmes, person-to-person communication or written information about the patient’s conditions should be made between different parties. | 4 | 1 | 4.29 | 0.81 | 4 | 1 | 4.38 | 0.58 | 4 | 1 | 4.17 | 0.64 | |