Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement.

Autor:	Jeffery S; Centre for Health Services Studies, University of Kent, Canterbury, UK s.jeffery@kent.ac.uk.; NIHR Applied Research Collaboration Kent Surrey Sussex, Hove, UK., Monkhouse J; Centre for Health Services Studies, University of Kent, Canterbury, UK., Bertini L; NIHR Applied Research Collaboration Kent Surrey Sussex, Hove, UK.; Brighton and Sussex Medical School, Brighton, UK., Walker S; Centre for Health Services Studies, University of Kent, Canterbury, UK., Sharp R; Kent Surrey Sussex Academic Health Science Network, Crawley, UK.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2023 Dec 19; Vol. 12 (4). Date of Electronic Publication: 2023 Dec 19.
DOI:	10.1136/bmjoq-2023-002515
Abstrakt:	Background: Discharge to Assess (D2A) emerged as a critical process during the COVID-19 pandemic facilitating patient flow within hospitals, however research on the post-discharge community services of this pathway remains limited. We conducted an evaluation to examine the impacts, capacity, processes and barriers associated with D2A and to identify best practice across three sites in the southeast of England. Methods: We interviewed 29 commissioners, providers and staff members involved in the delivery of D2A pathways within three Health and Care Partnerships. Framework analysis of the collected data revealed three prominent themes: the commissioning of services encompassing funding, structure, culture, and expected outcomes; multidisciplinary collaboration including staff skills, team connections, and coordination; and information and knowledge exchange such as assessment methods, record management, and availability of operational insights. Results: 62 specific enablers and blockers to effective D2A practice emerged. Discussion: These findings supported the development of a comprehensive service improvement toolkit. Conclusion: Five recommendations are proposed: 1. Examination of pathways against the 62 enablers and blockers to identify and resolve pathway obstacles; 2. Establish a local operational policy accessible to all providers; 3. Enhance coordination and communication among service providers, patients and carers; 4. Strengthen oversight of service user flow; 5. Develop a consistent Patient Reported Outcomes Measure to facilitate feedback and service enhancements for individuals discharged from urgent care pathways. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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