Roles of the Multidisciplinary Team in Discharge Planning from Hospital: Difference between revisions
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* Creating ongoing treatment plan. <ref name=":2">Wright JR, Koch-Hanes T, Cortney C, Lutjens K, Raines K, Shan G, Young D. [https://pubmed.ncbi.nlm.nih.gov/34935968/ Planning for Safe Hospital Discharge by Identifying Patients Likely to Fall After Discharge]. Phys Ther. 2022 Feb 1;102(2)</ref> | * Creating ongoing treatment plan. <ref name=":2">Wright JR, Koch-Hanes T, Cortney C, Lutjens K, Raines K, Shan G, Young D. [https://pubmed.ncbi.nlm.nih.gov/34935968/ Planning for Safe Hospital Discharge by Identifying Patients Likely to Fall After Discharge]. Phys Ther. 2022 Feb 1;102(2)</ref> | ||
* Management advice. <ref name=":2" /> | * Management advice. <ref name=":2" /> | ||
* Equipment prescription and provision.<ref>WellChild. Appendix B1: Discharge Checklist: child/young person with complex needs/NIV. Available from: https://www.wellchild.org.uk/wp-content/uploads/2021/07/Appendix-B1-Discharge-Checklist-CYP-with-complex-needs-NIV.pdf (Accessed 28/08/22)</ref> | * Equipment prescription and provision.<ref name=":7">WellChild. Appendix B1: Discharge Checklist: child/young person with complex needs/NIV. Available from: https://www.wellchild.org.uk/wp-content/uploads/2021/07/Appendix-B1-Discharge-Checklist-CYP-with-complex-needs-NIV.pdf (Accessed 28/08/22)</ref> | ||
* [[Balance]] and [[falls]] assessment and onwards referrals.<ref name=":2" /> | * [[Balance]] and [[falls]] assessment and onwards referrals.<ref name=":2" /> | ||
* Participate in family meetings.<ref name=":4">Waring J, Marshall F, Bishop S, et al. An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge. Southampton (UK): NIHR Journals Library; 2014 Sep. (Health Services and Delivery Research, No. 2.29.) Chapter 4, Discharge planning and care transition. Available from: https://www.ncbi.nlm.nih.gov/books/NBK259993/ | * Participate in family meetings.<ref name=":4">Waring J, Marshall F, Bishop S, et al. An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge. Southampton (UK): NIHR Journals Library; 2014 Sep. (Health Services and Delivery Research, No. 2.29.) Chapter 4, Discharge planning and care transition. Available from: https://www.ncbi.nlm.nih.gov/books/NBK259993/ | ||
Line 44: | Line 44: | ||
* Onwards referrals. <ref name=":6" /> | * Onwards referrals. <ref name=":6" /> | ||
* May need to organize family meetings. <ref name=":4" /> | * May need to organize family meetings. <ref name=":4" /> | ||
==== Doctor ==== | |||
* Refer patients to other members of the multidisciplinary team as required. <ref>Hegarty C, Buckley C, Forrest R, Marshall B. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388067/ Discharge Planning: Screening Older Patients for Multidisciplinary Team Referral.] Int J Integr Care. 2016 Oct 10;16(4):1</ref> | |||
* Refer patients to other specialties as required. <ref>Ragavan MV, Svec D, Shieh L. [https://pubmed.ncbi.nlm.nih.gov/28450581/ Barriers to timely discharge from the general medicine service at an academic teaching hospital.] Postgrad Med J. 2017 Sep;93(1103):528-533.</ref> | |||
* Ensure patients can follow discharge instructions.<ref>Patel PR, Bechmann S. [https://pubmed.ncbi.nlm.nih.gov/32491751/ Discharge Planning]. 2022 Apr 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 </ref> | |||
* Communicate with patient and family regarding estimated discharge date and answer any questions.<ref>New PW, McDougall KE, Scroggie CP. [https://pubmed.ncbi.nlm.nih.gov/26439193/ Improving discharge planning communication between hospitals and patients.] Intern Med J. 2016 Jan;46(1):57-62.</ref> | |||
* Schedule any required tests or procedures early to prevent delays. <ref name=":0" /> | |||
* Deem when the patient is medically fit for discharge.<ref name=":3" /> | |||
* Prescribe medicines for discharge.<ref name=":3" /> | |||
* Complete discharge summary.<ref name=":3" /> | |||
==== Nurse ==== | |||
* Start planning early; planning can be aided by screening tools, risk assessment or care pathway.<ref name=":8">Nursing Times. [https://cdn.ps.emap.com/wp-content/uploads/sites/3/2013/01/130122-Effective-discharge-planning.pdf : The key principles of effective discharge planning.] 2013. Vol 109 No 3 </ref> | |||
* Identify whether patients with complex discharge needs. <ref name=":8" /> | |||
* Identify who is taking the role of discharge coordinator, as it is different between hospitals/wards. <ref name=":8" /> | |||
* Ongoing review of clinical management plan. <ref name=":8" /> | |||
* Communication with patient and their family. <ref name=":8" /> | |||
* Use a discharge checklist 24-48 hours before transfer/ discharge. <ref>Department of Health. Ready to go? Available from: https://www.sheffieldmca.org.uk/UserFiles/File/Ward_Collab/Ward_Principles/Ready_to_Go_Hospital_Discharge_Planning.pdf (Accessed 29/08/2022)</ref> | |||
* Arrange and partake in multidisciplinary meetings. <ref name=":3" /><ref>Goldman J, MacMillan K, Kitto S, Wu R, Silver I, Reeves S. [https://pubmed.ncbi.nlm.nih.gov/29607602/ Bedside nurses' roles in discharge collaboration in general internal medicine: Disconnected, disempowered and devalued?] Nurs Inq. 2018 Jul;25(3):e12236</ref> | |||
* Foster understanding between the MDT of the different roles to improve accountability and referral processes. <ref name=":8" /> | |||
* Arrange transport home. <ref name=":7" /> | |||
==== Discharge Coordinator ==== | |||
* Lead in planning and coordination patients’ discharge. <ref>Houghton A, Bowling A, Clarke KD, Hopkins AP, Jones I. [https://pubmed.ncbi.nlm.nih.gov/10158597/ Does a dedicated discharge coordinator improve the quality of hospital discharge?] Qual Health Care. 1996 Jun;5(2):89-96</ref> | |||
* Ensure the clinical, social and care needs of a patient have been assessed and met. <ref name=":9">Zurlo A, Zuliani G. [https://pubmed.ncbi.nlm.nih.gov/29313293/ Management of care transition and hospital discharge.] Aging Clin Exp Res. 2018 Mar;30(3):263-270</ref> | |||
* Establishing patient and family expectations. <ref name=":9" /> | |||
* Confirm the MDT to understand each disciplines roles and responsibilities in discharge planning. <ref name=":9" /> | |||
* Share knowledge of available services in the community or at home. <ref name=":9" /> | |||
==== Social Worker ==== | |||
* Assess the patients’ needs as well as their home and financial circumstances. <ref name=":4" /> | |||
* Arrange a package of [[Carers Guide to Dementia|care]] if required. <ref name=":4" /> | |||
* May act as a key worker or case manager. <ref name=":10">Abrams TE. [https://pubmed.ncbi.nlm.nih.gov/31878843/ Exploring the role of social work in U.S. burn centers.] Soc Work Health Care. 2020 Jan;59(1):61-73.</ref><ref name=":11">Holliman D, Dziegielewski SF, Teare R. [https://pubmed.ncbi.nlm.nih.gov/12971286/ Differences and similarities between social work and nurse discharge planners]. Health Soc Work. 2003 Aug;28(3):224-31.</ref> | |||
* Involvement for elderly patients with more complex cases or if there are difficulties with discharge destination placing. <ref>Auerbach C, Mason SE, Heft Laporte H. [https://pubmed.ncbi.nlm.nih.gov/17804339/ Evidence that supports the value of social work in hospitals]. Soc Work Health Care. 2007;44(4):17-32</ref> | |||
* Discharge planning policy making. <ref name=":11" /> | |||
* Patient and family counseling and advocacy .<ref name=":10" /><ref name=":11" /> | |||
* Supporting strategies for community reintegration. <ref name=":10" /> | |||
==== Pharmacist ==== | |||
* Giving pharmacotherapy recommendations .<ref name=":12">Li H, Guffey W, Honeycutt L, Pasquale T, Rozario NL, Veverka A. [https://pubmed.ncbi.nlm.nih.gov/27803504/ Incorporating a Pharmacist Into the Discharge Process: A Unit-Based Transitions of Care] Pilot. Hosp Pharm. 2016 Oct;51(9):744-751.</ref> | |||
* Identifying and correcting discharge medication discrepancies. <ref>Walker PC, Bernstein SJ, Jones JNT, et al. [https://pubmed.ncbi.nlm.nih.gov/19933963/ Impact of a Pharmacist-Facilitated Hospital Discharge Program: A Quasi-Experimental Study]. Arch Intern Med. 2009;169(21):2003–2010.</ref> | |||
* Dispensing discharge medicines. <ref name=":12" /> | |||
* Teaching patients and their caregivers about the medicines. <ref name=":12" /> | |||
==== Psychologist ==== | |||
* Assessment of patient’s needs, for [[Mental Health|symptom stabilization]] and treatment planning. <ref>Xiao S, Tourangeau A, Widger K, Berta W. [https://pubmed.ncbi.nlm.nih.gov/31039293/ Discharge planning in mental healthcare settings: A review and concept analysis.] Int J Ment Health Nurs. 2019 Aug;28(4):816-832</ref> | |||
* Liaison with patients’ family. <ref name=":13">Gowda M, Gajera G, Srinivasa P, Ameen S. [https://pubmed.ncbi.nlm.nih.gov/31040461/ Discharge planning and Mental Healthcare Act 2017]. Indian J Psychiatry. 2019 Apr;61(Suppl 4):S706-S709.</ref> | |||
* Referral to community services. <ref name=":13" /><ref>Hsiung DY, Lin EC, Lin KP, Lee MC. [https://pubmed.ncbi.nlm.nih.gov/20405398/ <nowiki>[Discharge planning: practical implementation in psychiatric care].</nowiki>] Hu Li Za Zhi. 2010 Apr;57(2 Suppl):S58-64</ref> | |||
* Utilizing published discharge planning checklists. <ref name=":13" /> | |||
==== Dietitian ==== | |||
* Identifying patients at risk for [[nutrition]] problems or who may require more support. <ref>Gordons Food Service. Nutrition's Vital Role in Discharge Planning. Available from: https://www.gfs.com/en-us/ideas/nutrition%E2%80%99s-vital-role-in-discharge-planning#:~:text=A%20dietitian%20or%20other%20food,require%20more%20care%20and%20attention (Accessed 29/08/2022)</ref> | |||
* Referrals to community dietitian, either in a clinic or for home visits. <ref name=":14">Laur C, Curtis L, Dubin J, McNicholl T, Valaitis R, Douglas P, Bell J, Bernier P, Keller H. [https://pubmed.ncbi.nlm.nih.gov/29361696/ Nutrition Care after Discharge from Hospital: An Exploratory Analysis from the More-2-Eat Study]. Healthcare (Basel). 2018 Jan 20;6(1):9 </ref> | |||
* Prescribing oral nutritional supplements for discharge.<ref name=":14" /> | |||
* Education for meeting nutritional needs at home, including meal delivery programs. <ref name=":14" /> | |||
=== Conclusion === | |||
== Resources == | == Resources == | ||
[https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Tool_1_IDEAL_chklst_508.pdf 'IDEAL' Discharge planning checklist] | |||
== References == | == References == | ||
<references /> | <references /> |
Revision as of 07:54, 29 August 2022
Original Editor - User Name
Top Contributors - Chloe Waller and Kim Jackson
Introduction[edit | edit source]
Successful discharge planning has positive implications for patients and healthcare staff. It reduces the hospital readmission rate at 1 and 3 months, reduces length of stay in hospital, increases the chance of patients returning to the same hospital, increases patient satisfaction and improves patient flow through the hospital.[1] [2] This reduces the risk of elective procedures being cancelled or patient being held in emergency departments or waiting in corridors.[3] Moreover, by reducing length of stay in hospital there is reduced the risk of hospital acquired infections, medication errors, thrombotic events, pressure ulcers, cognitive or functional decline.[3]
Multidisciplinary collaboration promotes effective discharge planning.[4] In order to have successful multidisciplinary team (MDT) discharge planning, there needs to be communication, coordination and collaboration between MDT members, understanding each disciplines roles, as well as patient involvement.[5]
Roles of the Multidisciplinary Team[edit | edit source]
Physiotherapist[edit | edit source]
- Identifying current physical and mobility status. [6]
- Ascertaining patients goals. [6]
- Collecting patients social history and home set up.[6]
- Creating ongoing treatment plan. [7]
- Management advice. [7]
- Equipment prescription and provision.[8]
- Balance and falls assessment and onwards referrals.[7]
- Participate in family meetings.[9]
- Training for families or carers. [10]
- Community referrals.[10]
Occupational Therapist[edit | edit source]
- Assess a patient’s level of function, including transfers/mobility, cognition and activities of daily living, and provide therapy to help them to reach their full potential.[10][11]
- Prescribe assistive equipment or environment modifications.[11]
- Gather information on patients home environment and previous level of function.[11]
- Collaborative goal setting and problem solving.[11]
- May need to organize family meetings. [9]
- Provide functional and psycho-emotional discharge and care plans to patients and their caregivers. [12]
Speech and Language Therapist[edit | edit source]
- Assess communication and swallowing disorders.[10]
- Advise on management of their findings.[10]
- Liaise with the MDT regarding the patients’ ability to understand information and express their wishes regarding discharge planning.[13]
- Create goals, treatment plan and follow up care, and share these with the patient, their family / carers and the MDT. [13]
- Onwards referrals. [13]
- May need to organize family meetings. [9]
Doctor[edit | edit source]
- Refer patients to other members of the multidisciplinary team as required. [14]
- Refer patients to other specialties as required. [15]
- Ensure patients can follow discharge instructions.[16]
- Communicate with patient and family regarding estimated discharge date and answer any questions.[17]
- Schedule any required tests or procedures early to prevent delays. [3]
- Deem when the patient is medically fit for discharge.[10]
- Prescribe medicines for discharge.[10]
- Complete discharge summary.[10]
Nurse[edit | edit source]
- Start planning early; planning can be aided by screening tools, risk assessment or care pathway.[18]
- Identify whether patients with complex discharge needs. [18]
- Identify who is taking the role of discharge coordinator, as it is different between hospitals/wards. [18]
- Ongoing review of clinical management plan. [18]
- Communication with patient and their family. [18]
- Use a discharge checklist 24-48 hours before transfer/ discharge. [19]
- Arrange and partake in multidisciplinary meetings. [10][20]
- Foster understanding between the MDT of the different roles to improve accountability and referral processes. [18]
- Arrange transport home. [8]
Discharge Coordinator[edit | edit source]
- Lead in planning and coordination patients’ discharge. [21]
- Ensure the clinical, social and care needs of a patient have been assessed and met. [22]
- Establishing patient and family expectations. [22]
- Confirm the MDT to understand each disciplines roles and responsibilities in discharge planning. [22]
- Share knowledge of available services in the community or at home. [22]
Social Worker[edit | edit source]
- Assess the patients’ needs as well as their home and financial circumstances. [9]
- Arrange a package of care if required. [9]
- May act as a key worker or case manager. [23][24]
- Involvement for elderly patients with more complex cases or if there are difficulties with discharge destination placing. [25]
- Discharge planning policy making. [24]
- Patient and family counseling and advocacy .[23][24]
- Supporting strategies for community reintegration. [23]
Pharmacist[edit | edit source]
- Giving pharmacotherapy recommendations .[26]
- Identifying and correcting discharge medication discrepancies. [27]
- Dispensing discharge medicines. [26]
- Teaching patients and their caregivers about the medicines. [26]
Psychologist[edit | edit source]
- Assessment of patient’s needs, for symptom stabilization and treatment planning. [28]
- Liaison with patients’ family. [29]
- Referral to community services. [29][30]
- Utilizing published discharge planning checklists. [29]
Dietitian[edit | edit source]
- Identifying patients at risk for nutrition problems or who may require more support. [31]
- Referrals to community dietitian, either in a clinic or for home visits. [32]
- Prescribing oral nutritional supplements for discharge.[32]
- Education for meeting nutritional needs at home, including meal delivery programs. [32]
Conclusion[edit | edit source]
Resources[edit | edit source]
'IDEAL' Discharge planning checklist
References[edit | edit source]
- ↑ Henke RM, Karaca Z, Jackson P, Marder WD, Wong HS. Discharge Planning and Hospital Readmissions. Med Care Res Rev. 2017 Jun;74(3):345-368
- ↑ Gonçalves-Bradley DC, Lannin NA, Clemson LM, Cameron ID, Shepperd S. Discharge planning from hospital. Cochrane Database Syst Rev. 2016 Jan 27;2016(1)
- ↑ 3.0 3.1 3.2 Ibrahim H, Harhara T, Athar S, Nair SC, Kamour AM. Multi-Disciplinary Discharge Coordination Team to Overcome Discharge Barriers and Address the Risk of Delayed Discharges. Risk Manag Healthc Policy. 2022 Feb 2;15:141-149.
- ↑ Patel H, Yirdaw E, Yu A, Slater L, Perica K, Pierce RG, Amaro C, Jones CD. Improving Early Discharge Using a Team-Based Structure for Discharge Multidisciplinary Rounds. Prof Case Manag. 2019 Mar/Apr;24(2):83-89.
- ↑ Carroll A, Dowling M. Discharge planning: communication, education and patient participation. Br J Nurs. 2007 Jul 26-Aug 8;16(14):882-6
- ↑ 6.0 6.1 6.2 Jette DU, Grover L, Keck CP. A qualitative study of clinical decision making in recommending discharge placement from the acute care setting. Phys Ther. 2003 Mar;83(3):224-36
- ↑ 7.0 7.1 7.2 Wright JR, Koch-Hanes T, Cortney C, Lutjens K, Raines K, Shan G, Young D. Planning for Safe Hospital Discharge by Identifying Patients Likely to Fall After Discharge. Phys Ther. 2022 Feb 1;102(2)
- ↑ 8.0 8.1 WellChild. Appendix B1: Discharge Checklist: child/young person with complex needs/NIV. Available from: https://www.wellchild.org.uk/wp-content/uploads/2021/07/Appendix-B1-Discharge-Checklist-CYP-with-complex-needs-NIV.pdf (Accessed 28/08/22)
- ↑ 9.0 9.1 9.2 9.3 9.4 Waring J, Marshall F, Bishop S, et al. An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge. Southampton (UK): NIHR Journals Library; 2014 Sep. (Health Services and Delivery Research, No. 2.29.) Chapter 4, Discharge planning and care transition. Available from: https://www.ncbi.nlm.nih.gov/books/NBK259993/
- ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 East London Health & Care Partnership. Roles and responsibilities in discharge planning. xAvailable from:https://www.eastlondonhcp.nhs.uk/downloads/ourplans/Children/Professionals/Discharge%20roles%20and%20responsibilities.pdf (Accessed 28/08/22)
- ↑ 11.0 11.1 11.2 11.3 Enhance OT. Discharge Planning OT Services. Available from: https://enhanceot.com.au/discharge-planning-ot-services (Accessed 27/08/2022)
- ↑ Nunes HJ, Queirós PJ. Patient with stroke: hospital discharge planning, functionality and quality of life. Rev Bras Enferm. 2017 Apr;70(2):415-423.
- ↑ 13.0 13.1 13.2 Aphasia Pathway. Discharge Planning. Available from: http://www.aphasiapathway.com.au/?name=Discharge-planning#:~:text=Speech%20pathologists%20should%20be%20part,with%20the%20receiving%20healthcare%20providers. (Accessed 27/08/2022)
- ↑ Hegarty C, Buckley C, Forrest R, Marshall B. Discharge Planning: Screening Older Patients for Multidisciplinary Team Referral. Int J Integr Care. 2016 Oct 10;16(4):1
- ↑ Ragavan MV, Svec D, Shieh L. Barriers to timely discharge from the general medicine service at an academic teaching hospital. Postgrad Med J. 2017 Sep;93(1103):528-533.
- ↑ Patel PR, Bechmann S. Discharge Planning. 2022 Apr 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022
- ↑ New PW, McDougall KE, Scroggie CP. Improving discharge planning communication between hospitals and patients. Intern Med J. 2016 Jan;46(1):57-62.
- ↑ 18.0 18.1 18.2 18.3 18.4 18.5 Nursing Times. The key principles of effective discharge planning. 2013. Vol 109 No 3
- ↑ Department of Health. Ready to go? Available from: https://www.sheffieldmca.org.uk/UserFiles/File/Ward_Collab/Ward_Principles/Ready_to_Go_Hospital_Discharge_Planning.pdf (Accessed 29/08/2022)
- ↑ Goldman J, MacMillan K, Kitto S, Wu R, Silver I, Reeves S. Bedside nurses' roles in discharge collaboration in general internal medicine: Disconnected, disempowered and devalued? Nurs Inq. 2018 Jul;25(3):e12236
- ↑ Houghton A, Bowling A, Clarke KD, Hopkins AP, Jones I. Does a dedicated discharge coordinator improve the quality of hospital discharge? Qual Health Care. 1996 Jun;5(2):89-96
- ↑ 22.0 22.1 22.2 22.3 Zurlo A, Zuliani G. Management of care transition and hospital discharge. Aging Clin Exp Res. 2018 Mar;30(3):263-270
- ↑ 23.0 23.1 23.2 Abrams TE. Exploring the role of social work in U.S. burn centers. Soc Work Health Care. 2020 Jan;59(1):61-73.
- ↑ 24.0 24.1 24.2 Holliman D, Dziegielewski SF, Teare R. Differences and similarities between social work and nurse discharge planners. Health Soc Work. 2003 Aug;28(3):224-31.
- ↑ Auerbach C, Mason SE, Heft Laporte H. Evidence that supports the value of social work in hospitals. Soc Work Health Care. 2007;44(4):17-32
- ↑ 26.0 26.1 26.2 Li H, Guffey W, Honeycutt L, Pasquale T, Rozario NL, Veverka A. Incorporating a Pharmacist Into the Discharge Process: A Unit-Based Transitions of Care Pilot. Hosp Pharm. 2016 Oct;51(9):744-751.
- ↑ Walker PC, Bernstein SJ, Jones JNT, et al. Impact of a Pharmacist-Facilitated Hospital Discharge Program: A Quasi-Experimental Study. Arch Intern Med. 2009;169(21):2003–2010.
- ↑ Xiao S, Tourangeau A, Widger K, Berta W. Discharge planning in mental healthcare settings: A review and concept analysis. Int J Ment Health Nurs. 2019 Aug;28(4):816-832
- ↑ 29.0 29.1 29.2 Gowda M, Gajera G, Srinivasa P, Ameen S. Discharge planning and Mental Healthcare Act 2017. Indian J Psychiatry. 2019 Apr;61(Suppl 4):S706-S709.
- ↑ Hsiung DY, Lin EC, Lin KP, Lee MC. [Discharge planning: practical implementation in psychiatric care]. Hu Li Za Zhi. 2010 Apr;57(2 Suppl):S58-64
- ↑ Gordons Food Service. Nutrition's Vital Role in Discharge Planning. Available from: https://www.gfs.com/en-us/ideas/nutrition%E2%80%99s-vital-role-in-discharge-planning#:~:text=A%20dietitian%20or%20other%20food,require%20more%20care%20and%20attention (Accessed 29/08/2022)
- ↑ 32.0 32.1 32.2 Laur C, Curtis L, Dubin J, McNicholl T, Valaitis R, Douglas P, Bell J, Bernier P, Keller H. Nutrition Care after Discharge from Hospital: An Exploratory Analysis from the More-2-Eat Study. Healthcare (Basel). 2018 Jan 20;6(1):9