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Indiana University-Purdue University Indianapolis (IUPUI) / Postdischarge follow-up appointments are widely thought to improve the safety of transition for patients moving from the hospital to home. They provide an opportunity for outpatient primary care providers to detect problems or failures of postdischarge care. Readmissions can be used to reflect the quality of postdischarge or transitional care. This study evaluated whether patients with an outpatient follow-up appointment scheduled with their primary care provider within five calendar days of discharge had fewer 30-day readmissions than those patients who had appointments scheduled six days or longer from discharge. No difference in readmission rate was detected between the two groups.

Discharge planning is an integral part of patient care, which involves the transfer of patients from the hospital to the community, taking into account the patient’s unique and complex needs. However, this process is often fraught with complexities. This study was designed to explore challenges of current practices in discharge planning and to establish factors and effective strategies for future management. A qualitative and descriptive study was undertaken to understand the views of health care professionals on discharge planning within a tertiary hospital setting in KwaZulu-Natal. A comprehensive, rather than a disease-specific approach was used. Systems theory and the bio-psycho-social model formed the appropriate theoretical framework for the current study, which considered a holistic approach, taking into account systemic factors, relationships, physical, psychological and social aspects of patient care. Purposive sampling was used to identify 26 members of the multidisciplinary team with the relevant knowledge and experience. Semi-structured interviews, that were audio-recorded, were undertaken as the primary method of data collection, from which transcripts were thematically analysed. The study identified the key themes in terms of major challenges that included inter-hospital transport and referrals, resource constraints, patient compliance, and caregiver preparedness. The poor socio-economic circumstances of patients and their families formed a grim background. A documentation analysis of discharge summaries, utilized as a secondary method for the purposes of triangulation, revealed inconsistencies in the discharge summary system that varied between incomplete or well written reports. Based on the study findings, recommendations are made in respect of practice, policy and further research in the designated area of study. Some of the strategies recommended include collaboration with the multidisciplinary team, improving patient and caregiver education and establishing a formalized system of discharge planning, policies and discharge summaries. / M.A. University of KwaZulu-Natal, Durban, 2014.

[Truncated abstract] Background: This thesis examines pharmacotherapy use in the secondary prevention of coronary heart disease. It includes antiplatelet agents, beta-blockers, statins and ACE inhibitors, all shown in landmark clinical trials and meta-analyses to reduce the risk of cardiac events in patients with known coronary disease. Underuse of effective preventive therapies represents a lost opportunity to reduce mortality and morbidity. Overseas studies have shown significant underuse of effective therapies at the time of hospital discharge following an acute event and later in ambulatory care. Australian data on prescribing practices following an acute coronary event and, ongoing use in ambulatory care are sparse. Aims: The aim of this thesis was to quantify the prescription of known effective therapies at the time of hospital discharge following an acute coronary event and ongoing use in ambulatory care. A secondary aim was to identify barriers to optimal secondary prevention thus providing an evidential basis to recommend change. Methods: This was an observational study of a cohort of post-MI patients admitted to a tertiary and affiliate hospital in Perth, Western Australia. The continuum of care from the treatment plan at discharge through to the treatment regimen and risk factor management 12 months post-MI was examined. The intermediate step, communication about the treatment plan with the patient and the primary health care provider was also examined. The study involved a review of hospital medical records and follow-up questionnaires to patients and their general practitioners at 3 and 12 months post-MI. All post-myocardial patients were included in the analysis of prescriptions at discharge. The follow-up study included patients 80 years and younger with no terminal conditions. Patient interviews at 3 months and interviews and focus groups with key hospital staff provided qualitative data to inform the quantitative data.

The Best PhD Thesis in the Faculties of Architecture, Arts, Business & Economics, Education, Law and Social Sciences (University of Hong Kong), Li Ka Shing Prize, 2003-2005. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

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Contends that poor discharge planning for elderly patients in American hospitals is the result of reduced lengths of stay which do not give medical social workers adequate time to assess patients' needs. A survey methodology was used to assess social service and community resource needs of hospitalized elderly patients and their family members at Riverside Community Hospital in California. Argues that the results of the survey can be used to improve discharge planning and lead to a more client-centered practice in hospitals.