Why is Discharge Planning Important for People Over 65; UK Case Study
Discharge planning is the process of preparing the patients to leave the hospital and starts the moment a patient is admitted. It is regarded as one of the paramount activity in any clinical setup, as it helps to anticipate the kind of care to be given in the hospital and after the person is released back to the community. Due to the age differences, professionals find it difficult to equalize the nature of services. The proposition is supported by Huang (2015, p.142) who noted that older adults require more specialized care, as their needs are more complex compared to the youths.
Taking a case study of hospitals in the UK, about 65% of the people seeking emergency attention comprises of the old people, who report various cases like diabetes, strokes, among others, that come along with age (Domoto et al. 2014, p.87). Such, the hospitals are pressured to give specialized care, that is focused on continues evaluation on the health performance of the bedridden patients. Similarly, deciding on the procedure of discharge is essential, since old people get complications rapidly, hence the need for making an accurate decision before allowing the patient to leave the hospital.
According to Kleinpell (2015, p.130), he noted that discharge care entails identification, assessing the patient, setting the goals, planning, implementation, coordination, and evaluation. Based on his argument, he pointed out that the moment a patient report into any healthcare facility, the medics begins by assessing the problem, by invoking several procedures such as tests, to be sure the kind of the disease to treat. Later, the treatment plan begins, with a setting goal of enhancing the recovery of the patient. While the stipulated procedures might work for a broad age group of patients, aged people are challenging to manage (Domoto et al. 2014, p.87). Some reports to the hospitals in critical conditions, due to their susceptibility to infections, as their immune systems are weak. Therefore, understanding their requirements beyond the tests is paramount, entailing both emotional and physical support. New et al. (2016, p.61) reported that about 20% of the hospitals in the UK affirmed ofhaving been forced to conduct more than two tests, to diagnose accurately, the diseases among the old people aged above 65 years of age. Similarly, they reported about 40% of those discharged from the hospitals came back after three months, with either similar or different diseases (Huang 2015, p.142). The issue that was pointed out to have contributed to these effects is the lack of proper discharge planning, whose adoption could reduce the high chances of return back to the hospitals.
Continuity of quality healthcare is dependent on how well the patients are managed from the time they report in the hospital. The previous studies, one conducted by Kleinpell (2015, p.80) noted that discharge planning could be divided into two categories. The first one is informal, that is ordinary. It only focuses on the previous and unguided formats of admitting and discharging of the patients. The second is formal, which gives specialized structured attention to a particular group of people. The aged and people with special needs fall under this category because they demand more compared to other groups of patients. Such, the length of stay in the hospital is highly reduced. Therefore, this paper will critically review the importance of discharge planning for people over 65 coming from the hospital in the UK.
Statement of the problem
More than two-fifths of health spending in the UK is channeled to the old people, who are aged 65 years and above. According to the information released by the Guardian (2019), the figure of the spending is estimated to increase in the following years, contributed to by the aging demographics. The data demonstrates that the country spends seven times on health care for a person aged 85 years, more than a young person in the late ages of 30. Furthermore, the cost of health steeply increases from the age of 50, which has been a significant point of concern for the UK, to figure out on the best ways to capitalize on discharge planning, to mitigate the regular return to the hospitals. Currently, there are about 11.4 million people, who are aged 65 years and above, which represent an estimate of 18%(Guardian 2019, n.p). This has imparted pressure on the government, as the funding for healthcare becomes strenuous. In the same vein, the figure is projected to rise by 2039 to 23% if the services in various hospitals do not change. To continually fund quality care, the government has to look for funds, which could be used to finance other sectors of the economy. Sustaining such a system puts pressure on the working class because the aged are dependent. Finding a way to mitigate the spending on healthcare, probably by reducing the frequency of going to the hospital would significantly save on costs.
Aim of the Study
The main purpose of this paper is to evaluate the importance of discharge planning for people over 65 coming from the hospital in the UK. The paper will review the secondary sources, and shed insight concerning the issues, by considering the responses of different authors who have argued for and against the topic. The appraisal will help in identifying some of the opportunities that the UK hospitals can leverage on, to improve the process of discharge and consequently progressing quality healthcare among the people aged above 65 years at a lower cost.
Rationale of the Study
The previous studies have shown that proper discharge planning is elemental for proper recovery of the patients. According to Huang (2015, p.102) he discussed some of the challenges that arise while executing the discharge planning, and noted that lack of good will from the staff (medical practitioner’s heightened the cases of readmission. The same is echoed by Kleinpell (2015, p.135) whose study primarily focused on the challenges that old people face, while being admitted in the hospitals. The current paper addresses the case of proliferated readmission in the hospitals, due to lack of support system from the staff, who rarely follows the old people after being released from the hospital. In a number of hospitals around the UK, the soaring number of patients admitted per a given time impart pressure on the medical practitioners, and the most overworked group are nurses. Due to the increased patient’s population, especially the old people, it becomes difficult to offer complete follow-up after being discharged, which increases the chances of going back to the hospital again. The medical professionals up to date have not acknowledged the need of more support system, after the old patients are released from the hospitals, which impeded quality health care in the UK.
Research questions
- What is the hospital discharge planning process?
- What are impacts of delayed discharge planning?
- What is the importance of discharge planning?
- What are the significant barriers to discharge planning?
Research objectives
- To illustrate the hospital discharge planning process
- To determine the impacts of delayed discharge planning?
- To evaluate the importance of discharge planning.
- To establish the significant barriers to discharge planning.
The rest of the study will be structured in the following format. The first section will review the secondary sources and critique the thoughts of various researchers and will be titledliterature review. It will be followed by the methodology section, that will detail the approach taken by the researchers, to collect the data, the design adopted and the sampling technique. Finally, the paper will sum up the arguments by amalgamating all the ideas discussed in the entire study.
Literature review
For the older patients in the UK, the discharge decisions are paramount for it can affect the rest of their lives. Changes in the healthcare environment have made it hard to do proper planning, hence risking the lives of the patients who are at optimal stages in life. According to Huang (2015, p.102), the rise of the managed care and home-based nursing services have predominantly surrounded the health sector. He noted that some of the medical professionals make rapid decisions to discharge a patient before full recovery which heightens the chances of going back to the hospital again. The proposition is seconded by Domoto et al.(2014,p.82) who noted in his study that the acuity of home-based care services has continually retrogressed the quality of health services of the old people in the UK, thus exposing them to more dangers. He affirmed the needs of retaining the patients for more extended periods to monitor their conditions until they stabilize. However,Kleinpell (2015, p.132) is of the contrary opinion, by arguing that continued retention of the old patients increases the cost of health care to government, and the new changes that appreciate homecare services should be embraced. Nevertheless, the quality of the home care nursing raises eyebrows, in regards to its the possibility of handling the emergencies.
Development of discharge planning
The elevation of discharge planning started in the united states in the late 1960s (Fuller et al. 2013, p.150). The development was adopted by the health care regulation authority, with the principal aim of improving the healthcare of all people, regardless of age. However, the changes and the invention were derived from the increased cases of readmissions, especially among old people. Fuller et al. (2013, p.148) noted that the acceptance was focused on achieving optimum post-discharge care, that was perceived elemental, to mitigate the mortality rate in the country. The main challenge that faced this new invention was the facts that it was affected by the ethical issues among them being, respecting the patient rights, the cost of maintaining the system, and lack of enough human labor to take care of the patients outside the hospital. In the same vein, Hoyer et al. (2016, p.398) are of the idea that effective post discharge care should entail proper communication between the hospital and the community.
Brown et al. (2014, p.94) noted that discharge planning follows a sequenced process, that enables the staff, to ensure that the patient’s health is stabilized. The first step is identifying the patients who need the assistance. In a hospital setup, there exist infirm with varied conditions, and some requiring more specialized care than the others. It is the responsibility of the nurse, doctor, or a clinician, to asses and evaluate the criticality of the disease, and recommend planning for discharge. According to Goodman et al. (2013,406), old people fall under this category because they present complicated cases, that are attached to other ailments. In his study, he evaluated the performances of hospitals in regards to managing the patients in old ages, above 65 years, and concluded that only identified severe cases are well maintained, and their discharge planning is done accurately. However, the paper concludes by supporting that the unidentified examples are more, which results in heightened readmissions.
The second stage of discharge planning involves liaising with different stakeholders, in this case, the family members, patient, and the team in the medical field, to ensure a smooth transition from the hospital to their homes. In this case, the medical team explains to the immediate family member, concerning the health progress of the patient, and several connotations are made with the experts, to give a go-ahead of discharge. Henke et al. (2015, p.352) noted that communication is elemental in planning for the release of patients since they are instructed on how to use drugs and the kind of foods to eat. His remarks are seconded by Brown et al. (2014, p.92) who propounded that the lack of proper changeover from the hospital to the community, and consequently increasing the challenges of readmission is as a result of poor connection between the patient’s family members and the hospital fraternity. Likewise, he furthered his arguments by alluding that the patients are returned at later dates with more severe complications, which is costly to the family members to finance the hospital bill. Also, the phenomenon exerts pressure on the available resources, thus lowering the quality of healthcare offered in the country.
Furthermore, the third step is recommending the available options to continue the healthcare of the patients, which might include the programs and accommodation facilities where such services can be accessed (Henke et al. 2015, p.353). Old people require a personalized approach and care, which might lack if the immediate family members are not tolerant. Among the services, they request assistance for are trivial but might complicate their cases further, if not addressed accordingly. Having professional assistance close to them would help in identifying any change in their health. They need support -both physical and emotional, hence the necessity for a program that can assist in achieving the two. The fourth step consists of liaising with the agencies or facilities to promote the patients in accessing the services efficiently. Finally, encouragements of the patients and the family members are required, to give them hope. Hoyer et al. (2016, p.399) affirm that the procedure is not static and might change based on the nature of the patients that are under treatment.
Fuller et al. (2013, p.154) conducted a study among the public hospitals in the UK, to assess the effectiveness of discharge planning midst the old people. Interviewing around forty senior doctors in the different hospitals, he noted that the procedure discussed in the previous paragraphs could only apply to a few patients in critical conditions. The reason that was forward by 70% of the participants alluded that lack of enough personnel was the principal reason for the increase in post-discharge care. Also, they cited that the staff never acknowledged the need for follow-up care due to high workload and the swelling number of patients served per given time. The revelation unearthed a new form of challenge that runs across all hospitals in the UK -high rate of turnover due to overworking of the medical practitioners. This can be directly linked to the derailed discharge planning among the aged patients, which is the only option to guarantee stabilized condition and reduced readmission.
Importance of discharge planning among the old people
One of the significant influence of discharge planning is that it reduces the impact of readmission. According to the study conducted by Shepherd et al. (2013, n.p), they noted that discharge planning could enable the medical practitioners, to detect the diseases among the old people, before it transitions to a more severe case. In his study, he noted that several people who get back to the hospital present previous symptoms, which accurately depicts that the primary care could have been defective.
To supplement his argument, Brown et al. (2014, p.87) connected the increased rate of regular visits to the hospitals by old people in the UK, to be linked by lack of proper handling in their first visit. Goodman et al. (2013, p.406) upholds that administering personalized care ensures that the patients complete the medication, and are offered enough motivation to continue with their healthy life. Fuller et al. (2013, p.153) established that comprehensive discharge planning reduced the rates of readmission of old patients with congestive heart failure. Based on his observation, he noted that several patients with this kind of disease are rushed to the hospitals after the worsening of the case, and the survival rate is minimal. Nevertheless, it is less likely known whether the circumstance of readmission happens in the same hospital, and if all the hospitals use a similar discharge planning procedure.
Huang (2015, p.503) affirmed in his study that discharge planning is vital in the reduction of the chances of readmission. This study focused on a fifty hospitals in the UK, both the private and government ones. The researcher administered the questionnaires among the lead doctors and nurses, to evaluate the cases of readmission midst the old people. The analysis of the questionnaires affirmed that in cases where the proper discharge planning was conducted, the chances of returning to the hospitals with similar complication was minimal. The observation is supported by Agustin (2017, p.170), who is of the idea that most of the hospitals lack an appropriate system, to manage the patients, which is the primary reason for them to require the implementation strategy of the discharge planning.
Furthermore, the other essential importance of discharge planning lies on saving the cost for both the patient’s family and the hospital. According to Muller (2013, p.120), the government uses hefty funds, in taking care of the health of the old people in the UK, which for quite some time has siphoned the budget. Based on the allocation of the funds for citizens’ health, the highest percentage is directed to the old people, in the form of insurance cover. The argument is seconded by MacPhail et al. (2013, p.482), who affirms that overstretching of a healthcare facility results in poor services, which consequently impacts the patients negatively since they fail to get personalized services. In regards to this, readmission after discharge piles pressure on the staff, and even the resources become strained.
On the part of the family members, they may be forced to pay extra monies. Bennet et al. (2019, p.126) confirmed in his study that individuals would prefer their patients to stay longer in the hospital, and come out having already stabilized, rather than allowing them to go home without fully remaining their health. The study exhibited that whenever such cases happen, the family members are affected in the sense that they have to keep a close watch and sometimes resort to taking them back to the hospitals. The proposition is critiqued by Graham et al. (2013, p.340), who argued that the current state of public hospitals which are popular to the citizens in the UK could not accommodate the surging number of patients. The phenomenon is contributed to by the issue of understaffing, which has forced the medical practitioners to overwork to meet the expected standards.
In the same vein, discharge planning is essential for the continuity of quality healthcare. The UK government values the health of the populace and considers that the aged people are instrumental since lack of care for such persons could heighten the burden on both the government and the family members. That forms the primary reason they are allocated the highest share in the health budget of the country. According to Muller (2013, p.115), quality health care is defined as those services, that ensures that the diseases are detected early, treated, and prevention strategies availed to the community to prevent further infections. When the patient is being released from the hospital, the medical practitioners are mandated to communicate to the immediate family members and give a guideline on how the infirm should conduct the rest of the life. Such information includes how to take drugs, the kind of foods to eat, among others. Making such information available to the family members and the patients helps to communicate the progress and probably seek further redress in case of a complication. According to Agustin (2017, p.167), the communication between the patient and the caregiver helps in quick recovery, as opposed to the case where the health professionals have no access to the information regarding the progress of the patient.
Moreover, Bennet et al. (2019, p.123) advocated that proper discharge planning improves the harmonization of services. Admission of the patients to the point of discharge entails a plethora of activities, among them being testing and administering of drugs. What is defined as proper planning by Muller (2013, p.108) involves making all parties involved in the caregiving services aware about the condition of the patient. The nurses, clinicians and doctors discuss the disease of the patient and come up with a way to treat it. All these are done with a projection of making sure that the person is discharged from the hospital.
Impact of delayed discharge planning
Delayed discharge is an issue that is affecting a considerable number of hospitals in the UK. It is defined by Graham et al. (2013, p.350) as the prolonged stay in the hospital, due to the unstable condition of the patient or lack of quality care contributed to by the overworking of the staff. Although the issue is discussed in regards to the UK, the problem has persisted in the world and attracted the WHO, to come up with a plan, through which the medical staff can implement to reduce the time of stay in the hospitals. Agustin (2017, p.153) noted that one of the impacts of delayed discharge is increasing the hospital bed occupancy. Old people are primarily challenging to manage, and therefore, they require close attention both in the hospital and in their homes. Due to the high number of patients, it becomes difficult to give top-notch management, which makes them take longer to heal, as their immune systems are not strong enough to fight slight infections. The length of stay has an indirect impact on other patients, since they lack bed space, thus denying them inpatient services.
According to Bennet et al. (2019, p.124), the high number of patients, especially the old people, places pressure on the staff since they have to continually go rounds to address their needs. They are a category of patients, who cannot do anything for themselves, and the nurses have a massive task of meeting their demands. The study conducted by Muller (2013, p.122) involving the job satisfaction of nurses in the selected fifty hospitals in the UK affirmed that most of the employees working in the public hospitals were not pleased with the working environment. They cited colossal pressure of work and working late hours to manage the high population as the primary causes of their dissatisfactions. It was also noted that similar affirmations resulted in a high rate of job turnover among the nurses, who opted to change career.
While some of the authors confirm that delayed discharge planning is caused by the management (Huang 2015, p.506), Muller (2013, p.108) contradicts the argument by upholding that the process is not a one-person activity. It involves the patient, community, the family members and the medical staff. All the parties have to be informed on the nature of the patients, to have a good transition from the hospital to the community. The reviewed studies have not identified some of the communication channels that can be employed, to ensure that the community and family members can reach to the medical practitioners within the hospital with less complication. This is an arena that should be studied more deeply to evaluate the possible ways that seamless flow of information regarding the patient can be relayed.
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Barriers to discharge planning
While the motive of the medical staff is to discharge the patients quickly, to create space for the others requiring bed attention, this is consistently made impossible by several factors. Bennet et al. (2019, p.123) noted that poor communication is one of the impediments, that enhances the chances of discharging the old patients. He stressed that transitioning the patient from the acute care in the hospital to community care requires multifaceted interaction among the patient, the hospital staff and the family members. The study further revealed that post-hospital complications happen to the aged people, due to lack of cooperation, and thus resulting in more sophisticated conditions, or even fatality. The gravity of leaving health care to the individuals who do not know the medical field needs sensitive attention. Hence communication plays a significant role in this case.
Effective communication can only happen if the professionals in the hospitals are trained and have the educational qualifications that befit the type of care demanded by the old people. For example, pediatrics cannot be given the role of managing the old patients, as their training is not focused on such services. McPhail et al. (2013, p.486) elucidates in his study that due to lack of enough medical staff, the management engages professionals, without selectively allocating them based on the competencies. He found out that the nurses taking the basic history at the admissions offices are sometimes rotated, and conduct rounds in the wards. The danger of adopting such a system is a lack of proper understanding of the patient, which could result in poor administration of drugs and inefficient care. Furthermore, Muller (2013, p.123) is of the idea that lack of training and education on the best practices for discharge planning, has resulted in more damages than anticipated. Quite often, the medical practitioners rely on what they have been doing for a decade, without considering the changes that might have happened in the procedure of discharging a patient. Of importance is the ability to segment the patients in terms of age since the way a young person would be released is different from the aged person. Therefore, a training entailing understanding the personal needs of the patient is essential, which is the prime objective of consideration before releasing the patient from the hospital.
Additionally, system and policies play a decisive role in obstructing the discharge planning. In a scenario where the bed capacity is low, it becomes difficult for the medical staff to determine which patient to release. The decision is made on comparing the severity of the illness (Graham et al. 2013, p.350) something that mitigates some of the patients from getting personalized care. Withal, the hiring policies have limited the number of staff that can be employed at a particular time, and consequently pilling pressure on the available labor force. Due to the enormous workload, it becomes difficult to follow the set-out procedure of discharge planning, and the medics opt to use the shortcut to make their work more accessible (MacPhail et al. 2013, p.485).
Patient preference is another issue that was reported by Bennet et al. (2019, p.124) as the barrier to discharge planning. In his study, he acknowledged that some of the old patients fail to leave the hospital, especially in cases where they lack a caregiver at home. Additionally, some of the healthcare professionals stated that old patients fail to understand the instructions on taking medications, which forces them to stay longer in the hospital and guaranteed quality surveillance. In a similar study conducted by Agustin (2017, p.172) he noted that social factors among them transportation, lack of family support and inadequate funding to have significant negative effects on the older patients. The sense of insecurity happens to worsen their conditions, and come along with associated psychological problems. As a result, the hospital management opts to retain them longer until their conditions stabilize at the expense of other patients requiring the bed attention.
In some conditions, the healthcare experts block the appropriate discharge plan, due to their busy schedule (Graham et al. 2013, p.353). He cites that nurses find it difficult to actualize the discharge plan on their own, in the absence of the physicians. The research conducted by Muller (2013, p.124) confirmed that physicians rotate in other hospitals, and spend less time in one facility to the other. Such, the nurses are left to take care of the patients on their own, and the contact between a nurse and physician is minimized. Lack of time to discuss the best plan to manage the patient after the discharge has curtailed the chances of offering quality care. The inhibition of the health professionals to the discharge planning should be studied, and possible solutions identified, to hasten the process of discharge of older patients. Finally, the resources outside the hospital are difficult to access. The aged are cleared and forwarded to the community and probably to individual care centers. One of the problems regarding private institutions is the charges could be high, beyond the affordability of the patient’s family. Thus, they resort to keeping infirm at home with little knowledge of what to do in case an emergency happens.
Methodology
The previous paragraphs have discussed the opinions and views of the different researchers, which have given an in-depth understanding of the issue of discharge planning among the aged people. The revelation that came out is that it is the responsibility of the patient, family members, and health professionals, to enhance harmony for the benefit of the patient. Likewise, some of the loopholes that mitigate proper planning have been identified, thus shedding more insight into the topic. The following paragraphs will discuss the approach that was taken to select the reference papers, which helped to form the basis of the argument.
Reasoning Method and Approach
Research is defined as the systematic method of evaluating the facts to create new knowledge. it entails collecting the data, processing, examining, and analyzing, to get a more profound meaning concerning the topic. The primary purpose of any research is to create fresh thinking, either to propagate what is already known, or innovate new concept to solve a social problem. There are two broad ways of reasoning, classified as inductive and deductive reasoning. Deductive reasoning focuses on examining a known theory, primarily by conniving the hypotheses and formulating the strategies to test them.
It moves from general to particular, hence referred to as top-down. On the other hand, inductive reasoning starts from a specific idea, and the researcher proceeds to make a theory, and is dubbed as bottom-top. In this study, the researcher adopted the inductive approach as more concern is laid on learning why is discharge planning important for people over 65 coming from the hospital in the UK. The conclusion is made from the data and information collected from the secondary sources and not on theory. The inductive approach might be inaccurate and misleading. Therefore, the output of this approach is probable and not absolute.
Choosing the correct methodology is dependent on the nature of the research or the issues presented in the research. Research with an inductive reasoning approach adopts the qualitative methodology, whose main element is use of secondary sources to evaluate the magnitude of the topic. The characteristic of qualitative research is to explain the trends between the research variables. The main reason for using the described methodology is that it affords the researcher an enormous amount of information, that cannot be accessed through the use of the quantitative methodology. Hence, it allows the collection of greater capacity data from other people’s observations.
Data collection is an instrumental stage in any research. Deciding on what to use to justify the objectives serves to validate the trustworthy of the study, hence the need for using reputable sources. In this case, the data source comprised of secondary sources. Books, peer-reviewed journals, and relevant databases were consulted, to get an overview of the issue of discharge planning for people over 65 coming from the hospital in the UK. The papers were search based on their relevance, and only those dated from 2013-2019 were selected to guide in this research.
Conclusion
Discharge planning for the old people is a complex issue, and requires corporate efforts, streaming from the family members and the medical professionals. The UK healthcare systems put more emphasis on the health of the aged citizens, and the highest portion of the health budget is allocated to them. Therefore, discharge planning is essential due to the following reasons that were identified in the previous paragraphs. One is minimizing the readmission rate, by ensuring the patients are given the appropriate follow-up while outside the hospital. The other one involved reducing the cost, on both the patient’s family and the hospital and finally enhancing the continuity of healthcare.
It was also noted that delayed planning impacted pressure on the staff due to high cases of readmission. The review of the secondary sources confirmed that overworking of the employees, lowered their interest to abide by the laid down procedures of conducting an ethical discharge. Such, errors occurred in the hospitals and unstable patients were released to the community, which heightened the cases of complications. Similarly, the paper acknowledged that some of the barriers to proper discharge planning include poor communication between the health providers and the family members, complex systems and policies within the hospital, patient preferences and intentional impediment contributed to by health professionals. Further research should be conducted to establish the contribution of understaffing to poor planning of hospital discharge for patients aged 65 years and above.
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