Spring 2008 - Newsletter

Stakeholders Provide Valuable Feedback In Working Toward The “Ideal” Day Hospital Discharge Process

“Together we are committed to improving our day hospital discharge process, minimizing risk, and assuring patient safety when a patient is discharged from any one of our day hospitals. We as clinicians and otherwise need to do our part to recognize and minimize risk factors, ensure all patients have continued access to community based services, and in turn ensure a more independent and safe home environment for our patients” states Team Lead, Dr. Cornelia van Ineveld, who herself serves as a day hospital geriatrician.

Four Winnipeg day hospitals are participating in this Canadian Patient Safety Institute funded project. Geriatric day hospitals provide outpatient multidisciplinary assessment and rehabilitation to older adults with complex health and issues. Patients usually attend the programs weekly for three to four months. During this time the day hospital team works closely with the patient, family members, family physicians, Home Care coordinators and community pharmacists.

As a means of gathering information about the current day hospital discharge process, stakeholders including patients, family and friends, clinicians, pharmacists, policy makers were invited to share their thoughts and experiences with our research team. The next step in this project is to review current communication and risk management practices in the day hospitals. Finally in September in large strategizing session will share findings and plan next steps for the day hospitals. As they prepare to venture into the upcoming Chart Review Phase, the research team is anxious to share some of their key findings to date as follows.

RISKS AT DISCHARGE:

Stakeholders were asked to reflect on the greatest risk faced by frail older adults on discharge from the day hospitals. Consistently stakeholder identified medication management issues and medication compliance as an ongoing risk. Lack of social support and informal caregivers were of concern. The risk of functional decline and therefore losing gains made in the program were frequently cited. Most patients attending day hospitals have several interacting chronic medical conditions. The difficulty accessing primary care physicians and ongoing community management from disciplines such as nursing, pharmacy and occupational therapy were of concern. Frequent re-referrals were thought to often result from the lack of alternative services for this population.

COMMUNICATION:

All stakeholder groups emphasized the importance of maintaining communication between all involved parties, especially at the time of discharge. Recommendations included increasing the frequency of face-to-face meetings and family conferences and increasing the frequency and distribution of interim updates. Technology was often cited as a barrier to communication between parties, specifically, in all sites privacy concerns preclude electronic forms of communication about mutual patients between providers/ agencies. Telephone, faxes and mail remain the relied on method of communication.

IMPROVING THE DISCHARGE PROCESS:

All day hospital teams described the importance of planning for discharge from the very start. Pre-discharge family conferences are often conducted, considered to be very helpful and most participants thought could occur more consistently. Written discharge summaries are routinely sent to family physicians and Home Care coordinators. Additionally providing a written summary to the patient and their family was a common recommendation. Simplifying and improving access to community programs such as Adult Day Programs and transportation options were identified as ways of smoothing the discharge process. All stakeholders were concerned about risks after discharge and a number of ways of adding in a follow up process were offered. Because of medication risks a pharmacy follow-up was also recommended.

For further information, please visit our newly created webpage linked to the Manitoba Institute for Patient Safety website located at http://mbips.ca/wp/patient-safety-in-day-hospital-transition/ or you are invited to contact the Research Coordinator at 478-6406.

This project is made possible through a grant from
The Canadian Patient Safety Institute.

In-kind sponsorship provided by:
Riverview Health Centre, University of Manitoba, Manitoba Health,
Winnipeg Regional Health Authority, and the Manitoba Institute for Patient Safety.