Understanding the hospital discharge planning process for medical patients with dementia.

Abstract

Background Poor hospital discharge processes can result in the readmission of patients and potentially increase the stress levels of carers. Therefore, this study sought to understand factors related to the discharge planning process for patients with dementia. Methods The researchers interviewed 32 carers of patients with dementia and 20 hospital staff who worked on medical wards in a United Kingdom (UK) hospital. The semi-structured interviews were analysed thematically using a systems theory (patient-carer-staff relationships, hospital equipment and policies). Results The findings indicated that the following factors could either have a positive or negative impact on discharge planning: patient (e.g. cognitive capacity), carer (e.g. preconceived ideas about care homes), staff (e.g. communication skills), policy (e.g. procedures such as discharge meetings), equipment (e.g. type of service provider delivering the equipment) and the wider social context (e.g. availability of specialist dementia beds in care homes). Conclusion It is important for hospital staff to adopt a systems perspective and to integrate the different elements of the hospital system when planning for patients’ discharge. Impact statement A systems approach can help to improve the discharge planning process for patients with dementia in hospital. Plain Language Summary Using a systems based semi structured interview guide, staff and carers were given the opportunity to discuss the discharge planning process. The discharge planning process starts with in-patients. The findings identified the barriers and facilitators of the discharge planning process through the lens of a systems framework. The results can support discussions amongst patients, staff, hospital managers, policymakers, academics, researchers and the wider general public on the best discharge practices.