Elsevier

Applied Nursing Research

Volume 16, Issue 3, August 2003, Pages 134-143
Applied Nursing Research

Original article
Hospital discharge referral decision making: a multidisciplinary perspective

https://doi.org/10.1016/S0897-1897(03)00048-XGet rights and content

Abstract

Patients discharged without home care referral were presented as case studies to nurses, social workers, physicians, and discharge planners experienced in discharge planning. Observations and tape-recorded interviews were used to identify patterns clinicians used when gathering information, determine information essential to discharge referral decisions, and explore why patients in need may not be referred for service. Clinicians collected information randomly, and content analysis of their interviews identified mental and functional status, treatment adherence, medical and co-existing conditions, medication management, social support, and prior hospitalization as essential information. Three themes describe why patients may not receive needed referrals: patient characteristics, workload and staffing, and educational issues. Suggestions for improved practice and further research are based on these themes.

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.

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