Background: Transition to the community is a critical phase for stroke survivors, yet effective discharge planning is often marred by poor communication, lack of patient participation and disorganised support services. High level evidence exists for achieving timely, patient-centred and interdisciplinary discharge planning however these approaches are not implemented consistently in inpatient clinical settings.
Aims: To determine discharge planning barriers in an inpatient rehabilitation setting for those with severe stroke and other non-progressive brain injuries and co-design solutions to improve discharge experiences for patients and families.
Methods: A problem analysis of discharge planning processes was conducted guided by the health services evaluation model PRECEDE-PROCEED. Participants were healthcare professionals working in inpatient rehabilitation and external stakeholders working with patients post-discharge. Data were obtained through medical file audit, a 30-item questionnaire, staff focus groups and a review of discharge policy documents. Quantitative data were analysed descriptively and qualitative data were analysed deductively using the National Safety and Quality Health Service (NSQHS) Standards for hospital discharge planning.
Results: Questionnaires were completed by forty-nine rehabilitation staff members (72% female) and fourteen external stakeholders (71% female). Focus group interviews (n=6) were completed with twenty-six staff members. Barriers to evidence-based and timely discharge included a lack of appropriate accommodation options and an inconsistent approach to discharge planning across team members. Suggested facilitators for coordinated discharge were clear and consistent communication and support for patient-family emotional adjustment. Gaps were identified in documentation to support discharge planning.
Conclusion: A theory-informed approach can guide the investigation of implementation issues in discharge planning practice. Establishment of a discharge pathway and checklist is a priority to improve discharge processes for patients and families.