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Current Opinion in Anaesthesiology Dec 2019Day surgery coming and leaving hospital day of surgery is growing. From minor and intermediate procedure performed on health patient, day surgery is today performed on... (Review)
Review
PURPOSE OF REVIEW
Day surgery coming and leaving hospital day of surgery is growing. From minor and intermediate procedure performed on health patient, day surgery is today performed on complex procedures and elderly patient and on patients with comorbidities. Thus, appropriate discharge assessment is of huge importance to secure safety and quality of care.
RECENT FINDINGS
Discharge has since decades been assessed on a combination of stable vital signs, control of pain and postoperative nausea and vomiting and securing that patients can stand walk unaided. There is controversy around whether patients must drink and void before discharge. The absolute need for escort when leaving hospital and someone at home first night after surgery is argued but it does support safety. Discharge is not being 'street fit,' it merely allows patients to go back home for further recovery in the home environment. A structured discharge timeout checklist securing that patients are informed of further plans, signs, and symptoms to watch out for and what to do in case recovery don't follow plans facilitate safety.
SUMMARY
Discharge following day surgery must be based on appropriate assessment of stable vital signs and reasonable resumption of activity of daily living performance. Rapid discharge must not jeopardize safety. Classic discharge criteria are still basis for safe discharge, adding a structured discharge checklist facilitates safe discharge.
Topics: Ambulatory Surgical Procedures; Anesthesia Recovery Period; Humans; Patient Discharge
PubMed: 31425193
DOI: 10.1097/ACO.0000000000000784 -
The American Journal of Nursing Dec 2014
Topics: Humans; Nursing Care; Patient Discharge; Planning Techniques; Practice Guidelines as Topic
PubMed: 25423376
DOI: 10.1097/01.NAJ.0000457394.98317.92 -
The Journal of Neuroscience Nursing :... Dec 2020Postcraniotomy individuals should be monitored because of the direct influence on brain function as well as constraints caused by underlying illness. The relationship...
BACKGROUND
Postcraniotomy individuals should be monitored because of the direct influence on brain function as well as constraints caused by underlying illness. The relationship between demographic and clinical characteristics of postcraniotomy individuals and their readiness for discharge was examined.
METHODS
A descriptive correlational study included 150 individuals. The Readiness for Hospital Discharge Scale and demographic variables were examined using descriptive statistics, correlation, and stepwise multiple linear regression.
RESULTS
The mean postcraniotomy score for the subdimension of knowledge related to readiness for discharge was 5.13 ± 3.04, and mean score for the whole scale was 7.76 ± 1.48. The individuals' age, employment status, presence of a person to provide care at home, poor financial status, and first hospitalization during the lifetime of the patient were statistically significant predictors of their readiness for discharge. This model was statistically significant (F = 25.572, P < .001) and accounted for 57% of the variance in discharge readiness.
CONCLUSION
Patients had moderate levels of readiness for discharge and low levels of discharge-related knowledge. The findings point to the importance of individual approach to the discharge planning.
Topics: Adaptation, Psychological; Adult; Aged; Correlation of Data; Craniotomy; Female; Health Literacy; Humans; Male; Middle Aged; Patient Discharge; Patients; Social Support; Turkey
PubMed: 32956132
DOI: 10.1097/JNN.0000000000000554 -
Intensive Care Medicine Aug 2019
Topics: Conflict of Interest; Ethics, Medical; Health Policy; Hospitalization; Humans; Patient Discharge; Politics
PubMed: 31267194
DOI: 10.1007/s00134-019-05673-3 -
The American Journal of Medicine Jun 2021Approximately 1%-2% of hospitalizations in the United States result in an against medical advice discharge. Still, the practice of discharging patients against medical... (Review)
Review
Approximately 1%-2% of hospitalizations in the United States result in an against medical advice discharge. Still, the practice of discharging patients against medical advice is highly subjective and variable. Discharges against medical advice are associated with physician distress, patient stigma, and adverse outcomes, including increased morbidity and mortality. This review summarizes discharge against medical advice research, proposes a definition for against medical advice discharge, and recommends a standard approach to a patient's request for discharge against medical advice.
Topics: Hospitalization; Humans; Patient Discharge; Risk Factors; Treatment Refusal; United States
PubMed: 33610522
DOI: 10.1016/j.amjmed.2020.12.027 -
Chest Sep 2015
Topics: Female; Humans; Male; Patient Care Bundles; Patient Discharge; Patient Readmission; Pulmonary Disease, Chronic Obstructive
PubMed: 26324144
DOI: 10.1378/chest.15-1131 -
Journal of Hospital Medicine Apr 2015
Topics: Bronchiolitis; Female; Humans; Length of Stay; Male; Patient Discharge
PubMed: 25627958
DOI: 10.1002/jhm.2323 -
Pediatrics Jun 2020
Review
Topics: Acute Disease; Child; Female; Home Care Services; Hospitalization; Humans; Male; Patient Discharge; Pediatrics
PubMed: 32467093
DOI: 10.1542/peds.2019-0074 -
Internal Medicine Journal Sep 2014Poor patient understanding of their diagnosis and treatment plan can adversely impact clinical outcome following hospital discharge. Discharge summaries are primarily... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND/AIM
Poor patient understanding of their diagnosis and treatment plan can adversely impact clinical outcome following hospital discharge. Discharge summaries are primarily written for the doctor rather than the patient. We determined patient understanding of the reasons for hospitalisation, in-hospital tests, treatments and post-discharge recommendations, and whether a brief patient-directed discharge letter (PADDLE) delivered during a brief discussion prior to discharge would improve understanding.
METHODS
A prospective randomised controlled trial was conducted, including 67 hospitalised patients. After a baseline questionnaire, patients were randomised to receive the PADDLE letter or usual care. Those receiving the letter had an immediate follow-up questionnaire. Patient understanding was compared with a summary letter written by the treating clinician, using a 5-point Likert scale ranging from none to full understanding. A questionnaire was administered at 3 and 6 months.
RESULTS
At baseline, patients had almost full understanding (median score 4) of reasons for hospitalisation and treatments. However, despite high self-appraisal, patients objectively had very little understanding of tests performed and post-discharge recommendations (median 2). Those receiving the letter had an immediate increase to almost full understanding (median 4) of tests performed (P < 0.001) and to full understanding (median 5) of post-discharge recommendations. This increase did not persist at 3 or 6 months.
CONCLUSIONS
A simple patient-directed letter delivered during a brief discussion improves patient understanding of their hospitalisation and post-discharge recommendations, which is otherwise limited. Further evaluation of this brief and well-received intervention is indicated, with the goal of improving patient understanding, satisfaction and clinical outcomes.
Topics: Australia; Communication; Correspondence as Topic; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Health Literacy; Hospitalization; Humans; Male; Middle Aged; Patient Discharge; Patient Education as Topic; Patient-Centered Care; Prospective Studies; Quality of Health Care; Surveys and Questionnaires
PubMed: 24863954
DOI: 10.1111/imj.12482 -
Australasian Emergency Care Mar 2020Emergency Department (ED) discharge involves the communication of healthcare information to optimise patient safety, selfmanagement, and understanding and compliance...
BACKGROUND
Emergency Department (ED) discharge involves the communication of healthcare information to optimise patient safety, selfmanagement, and understanding and compliance with ongoing treatment. However, little is known about the discharge practices or processesn undertaken by emergency clinicians. Therefore, the aim of this study was to explore the experience and perceptions of managing ED patient discharge by clinicians.
METHODS
A qualitative descriptive study was conducted in one district Tasmanian hospital. Data collection involved face to face interviews with emergency clinicians.
RESULTS
Twenty-one (36%) (12 medical officers, 6 registered nurses and 3 nurse practitioners) emergency clinicians agreed to participate in the study. From the data, five key themes emerged; (1) managing emergency department discharge; (2) Managing the workload of discharge; (3) Working as a team to support discharge; and (4) Building a safety net for the transition of care and (5) Improving emergency discharge.
CONCLUSIONS
Emergency discharge can be improved with the availability of a broader range of written patient discharge flyers, family and carer involvement, greater discharge role clarification, integration of electronic medical record and investigation ordering systems, defined nurse led discharge roles particularly after hours (after 4pm) to improve the safety of patient discharged.
Topics: Emergency Service, Hospital; Humans; Interviews as Topic; Nurses; Patient Discharge; Perception; Physicians; Qualitative Research; Statistics, Nonparametric; Tasmania
PubMed: 31926955
DOI: 10.1016/j.auec.2019.12.002