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

• Published in: BMC health services research 2023-05, Vol.23 (1), p.425-425, Article 425
• Main Authors: Gledhill, Kate, Bucknall, Tracey K, Lannin, Natasha A, Hanna, Lisa
• Format: Article
• Language: English
• Subjects: Admission and discharge; Clinical decision making; Coronaviruses; COVID-19; Critical care medicine; Data analysis; Data collection; Decision making; Discharge planning; Focus Groups; Health aspects; Health services; Hospitals; Humans; Inpatients; Interviews; Length of stay; Methods; Nursing; Patient Discharge; Patient readmission; Patients; Qualitative; Qualitative Research; Rehabilitation; Stakeholders; Sub-acute Care; Subacute Care
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-023-09285-y

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. 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. 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). 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.