Roles of the Multidisciplinary Team in Discharge Planning from Hospital
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]
Resources[edit | edit source]
- bulleted list
- x
or
- numbered list
- x
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 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)
- ↑ 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 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 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)