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The Discharge Planning Program
The discharge of patients is still one of the great unknown in Health. The transition from the acute services back into the community is “a rite of passage”, involving an ever-larger number of ageing patients with complex medical problems. Policy development has been substantial within this area. On this basis the expectations and assumptions of planners and managers are, that an efficient discharge plan will commence with a decision to admit a patient.
For the last two years the Simpson Centre has been closely involved with managers and clinicians in South Western Sydney in the evaluation of, and research into the complex processes associated with the discharge of patients. As a result of this collaboration, a significant knowledge gap was identified in regards to the extent to which policy had been implemented.
The design of this research is difficult, and the methodological challenges associated with the implementation of it continue to be substantial. The key strengths of the Simpson Centre has been a multi-disciplinary research team, working with managers and clinicians, across the interfase between the hospital and the community; as well as at the source of most entries into the hospital: the Emergency Departments.
The priority of this research is the patient welfare. New knowledge about the experience and satisfaction of patients and their carers is a key outcome. However it is part of the research strategy to explore the different levels of the system: the organisation of care, the staff issues and the patient perspectives simultaneously. The discharge program fits closely with the complex system intervention approach to Health Services Research endorsed by the Simpson Centre. The proof lie within the results: new knowledge that will ascertain whether policy was useful, relevant and affordable.
Identifying or designing appropriate tools that are valid and robust remain the most challenging task. This is confounded by the fact that up to 40% of the catchment population are from Culturally Diverse Backgrounds (CDB). An increasing proportions of CDB patients, representing earlier waves of immigration, are reaching the 70 years and older bracket. A significant number of these people have not adopted English as a preferred language or have reverted to their first language. The cross-cultural methods required for research exploring the discharge needs of this group of patients have become an important area of work for the Simpson Centre.
Similarly the Centre commenced a pilot project targeting residents from Residential Care Facilities, who utilise the Emergency Departments, or who are admitted to hospital. The discharge process and outcomes across this interphase are truly unknown. The lack of knowledge about how one might best align two such different organisational structures with entirely different funding models, to get the best deal for the patient, is a concern for managers and clinicians alike.
For more information on the Discharge Planning Project, please contact:
The Simpson Centre for Health Services Research
Liverpool Health Service
Locked Bag 7103
Liverpool BC NSW 1871
Tel: (02) 9828 6101
Fax: (02) 9828 6111
Email: info@simpsoncentre.org.au
