Original articleHospital discharge referral decision making: a multidisciplinary perspective☆
Section snippets
Design
A qualitative, exploratory design was chosen to describe health professionals’ perspectives of the discharge referral process. Case studies provided the context for gaining insight about their decisions. Procedures followed in this study included the use of information boards (Harte & Koele, 1997), observation of the participant’s information gathering process, semi-structured interviews, and content analysis guided by Colaizzi (1978).
Setting
This study was conducted at a large, urban, academic medical
Major findings
Participants approached the poster board collecting information in either a random pattern or consistently from top to bottom, even though the information was in a different order on each board. Information collection approaches did not reveal which categories they believed most important. Participants gathered all the information and then made a decision. When asked to identify characteristics that influenced referral decisions, all participants identified impaired functional status as an
Discussion
Discharge planning is a complex and demanding process that begins at hospital admission and requires the input, cooperation, and expertise of multiple clinicians. All models of discharge planning require the collection and synthesis of information to inform decision making (Potthoff, Kane, & Franco, 1995). Prior studies have not explored the manner in which clinicians gather information about their patient’s discharge needs. The content and quality of that information is critical to good
Summary
Significant barriers preventing effective discharge planning and decision making have been identified and confirmed in this and other studies. Serious and costly poor outcomes linked to inadequate discharge planning demand improved methods to systematically gather essential patient information and support the synthesis of information and subsequent decision making by health care professionals. Suggested strategies include basing the needs assessment on an organizing framework such as the Orem
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Supported by the National Institute of Nursing Research (NINR), NIH (RO1 NR02095) and the Frank Morgan Jones Fund of the University of Pennsylvania School of Nursing.