The discharge process can be strenuous for the patient, the hospital, and the nursing home staff. The process involves handling loads of paper to trace the patient to their admission details, give them dosage on drugs, and the next appointment if any. Reducing the time that patients take to go through this process makes discharge easier for them and the hospital administration. It is especially cumbersome when the hospital administration has to liaise with an external party such as family, sponsors, or health insurers to clear bills ( Ulin, Olsson, Wolf, and Ekman, 2016). Caregivers also need to understand what is expected of them before the patient leaves the hospital. Hospital to skilled nursing facility (SNF) transitions play an important role in the patient’s recovery. There are approximately 5 million transitions annually (Yam et al., 2015). To ensure that the patients receive optimum care following their discharge and admission to the nursing home, it is imperative that there is interdisciplinary collaboration between the facilities and caregivers. Communication and proper discharge planning is, therefore, vital in the transition of care delivery to patients.
Evidence-Based Interdisciplinary Plan
The communication between the hospital and nursing home must be accurate to ensure the patient continues to receive specialized care. This can be enhanced by applying technology in the discharge process. An integrated electronic healthcare records (EHR) system would be pivotal in relaying the patient information from the hospital to the nursing home. Details such as procedures and indications, medication, scheduled appointments, meals, hypersensitivity reactions, and other pertinent patient history can be input into the system and transmitted to the nursing home upon discharge of the patient. This will reduce the time the patient takes for discharge, as well as save the hospital staff the effort. This will ensure the patient follows the instructions to the latter with the aid of the nursing home staff.
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Every second in the health sector counts; thus, the efficiency of interdisciplinary communication determines how many lives can be saved. Developing the discharge system described above will link the various disciplines, such that practitioners will not have to make calls to inquire on the patient's information and progress. The discharge system will also reduce paperwork, which gets rid of the struggle to find patient documents or losing them. This system will also prevent human errors that could cost the patient’s life. These include wrong prescriptions and dosage. Errors that occur across disciplines are carried on without the next party realizing the mistake. According to the taxonomy of errors designed by Sasou and Reason, human errors are categorized into three: mistakes, lapses, and slips (Lei, Naveh, & Novikov, 2016). Mistakes and lapses occur in the thinking and planning process, while slips occur in the execution process Mistakes and lapses are rarely noted if the process moves to a new discipline since individuals who are following the initial instructions commit slips. This explains why designing the discharge system will make interdisciplinary communication more efficient.
In a study by Yam et al., (2015), the team used the Delphi methodology to assess the efficiency of the current manual discharge system. They found out that the lack of proper interdisciplinary communication was the most significant cause of errors in the process. In most cases, the discharge planning process, coordination, implementation of discharge, and post-discharge care did not end without an error. An automated system will, therefore, reduce these errors by providing consistent information throughout interdisciplinary transfers within the hospital and home-based care.
Change Theory
The planned change theory will be used to implement the proposal. The theory focuses more on the role and responsibility of those affected than on the process itself (Sonia & Joan, 2018). This approach will be used since interdisciplinary communication requires interpersonal interactions. The system will not eliminate personnel from the discharge process since empathy and personal relations are crucial in healthcare setups. It will only make communication easier. For instance, it will get rid of the long queues in the medical records department where different departments converge to retrieve information on patients who were admitted or being re-admitted. It will also consolidate information on individual patients on drug allergies and family history, which will ensure a caregiver does not have to repeat history taking during the discharge process. The planned change theory has seven stages: diagnosing the problem, assessing the chances of change, assessing the availability of resources, establishing its objectives and strategies, determining the role of those affected, the sustainability of the change, and making the change independent of supporting relationships.
Leadership Strategy
To implement this, visionary, flexible, and focused leadership is crucial. Transitional leadership is the most apt strategy to mediate a streamlined change and implementation of the communication strategy. Achieving interdisciplinary success requires collaboration and motivation from all disciplines (Cameron, 2015). The system requires that every discipline fills in the details of the patient immediately they check in, so that in the case that a patient needs to be discharged for a transfer to another health facility by emergency, the discharge process is fast, detailed and accurate. The leader will be required to earn the belief of possibility from the various disciplines, which will motivate the parties to participate in the project. Owning the project will give them the desire to see the results, which they know will lessen their workload. Disciplines also need to have a head of the implementation to improve the likelihood of achieving the objective. The leader in every department will ensure their team plays its roles. This leader is also an expert in the specific discipline, so will ensure the work meets standards. Taking an example of the triage, a nurse who has done the job for some time will be in the best position to evaluate whether the data that is input into the system will be helpful to the pharmacist who will administer drugs during discharge.
Organizational Resources and Plan Implementation
The communication system is a relatively cheap project to implement and maintain since it only requires staff training and use of technology to link interdisciplinary computers and to explain to caregivers how the system functions. Most health facilities already have the required infrastructure and will not have to incur extra costs. Smartphone applications will be developed for efficiency and portability. The application will have meal plans, drug dosage, and reminders on appointments. The caregivers can easily access and share the information with the nursing staff in nursing homes. Staff training will be done to introduce the project and motivate staff embrace the idea. Subsequent training will be a follow up on challenges and loopholes of the implementation of the project.
Failure to adopt the system and implement the interdisciplinary communication strategies will mean that the impediments to seamless care transition during discharge will prevail. As an example, information of an elderly patient and has been in vegetative state for a couple of months and needs to be transferred to a nursing home following discharge would be fundamental in designing his care in the nursing home. The patient requires specialized care, which can only be provided through effective interdisciplinary collaboration and communication between his primary caregivers and the nursing home. An integrated communication system would facilitate timely communication and relaying of accurate information.
Estimated Budget
|
Item/activity |
Estimated cost |
Purchase of additional computers |
$100,000 |
The first phase of training |
$5000 |
The second phase of training |
$5000 |
Application installation for customers |
$2000 |
Conclusion
Communication during the discharge process determines how fast the patient will recover since the information given at this stage determines what caregivers do. A health facility may have the best services, but have to re-admit patients due to lack of coordination in the transition of care from the hospital to a specialized nursing facility. Developing proper communication during discharge is thus essential for the recovery of the patient and gives the caregiver clear instructions on what is expected. A precise, detailed, and easy to understand discharge process significantly fastens the recovery process.
References
Cameron, K. (2015). Positive leadership: Strategies for extraordinary performance . Berrett-Koehler Publishers.
Lei, Z., Naveh, E., & Novikov, Z. (2016). Errors in organizations: An integrative review via level of analysis, temporal dynamism, and priority lenses. Journal of Management , 42 (5), 1315-1343.
Sonia, U., and Joan W. (2018). Common change theories and application to different nursing situations. Pressbooks . Retrieved on 25 th June 2019 from https://leadershipandinfluencingchangeinnursing.pressbooks.com/chapter/chapter-9-common-change-theories-and-application-to-different-nursing-situations/
Ulin, K., Olsson, L. E., Wolf, A., and Ekman, I. (2016). Person-centered care–An approach that improves the discharge process. European Journal of Cardiovascular Nursing , 15 (3), e19-e26.
Yam, C. H., Wong, E. L., Cheung, A. W., Chan, F. W., Wong, F. Y., and Yeoh, E. K. (2015). Framework and components for an effective discharge planning system: a Delphi methodology. BMC Health Services Research , 12 (1), 396.
