Successful service coordination for the homeless depends on the ability of diverse organizations to effectively collaborate. This study utilizes a life-cycle framework to expand on the collaborative governance theory by highlighting the different stages of collaboration that homeless service networks encounter. Activation, collectivity, and institutionalization are three stages used to uncover the unique nature of emergency discharge planning processes. Since collaboration is not a static process and government regulation for emergency discharge plans were recently enacted in 2012, collaborative networks encounter challenges and success factors at different stages. A qualitative case-study approach of organizational leaders in homeless service networks in Texas (Dallas, Ft. Worth and Houston) examines stages of collaboration. Results show common success and challenge factors identified among the three networks, but the factors take on different forms in relation to where the networks are at in the coordination stages. Practitioners can use the findings from this study as a guide to set up benchmarks and measurable objectives to identify strengths and weaknesses in their coordination processes.

Changes in the health-care system during the past decades have led to an increased transfer of health care to the home environment which also concerns patients treated with home enteral tube feeding (HETF). Research is scarce about how HETF care is functioning. Therefore, the overall aim with this thesis was to describe and explore HETF care and treatment from patients', relatives' and nurses' perspectives. Three qualitative and one quantitative study were used. The findings showed that the HETF treatment and care had a great impact on daily life for both patients and their relatives and implied many practical, emotional and social problems in their daily life, which they strived to manage. Side effects were common and the patients' reported low HRQL and general health. The amount and quality of received guidance and support from the health care, not least before discharge, turned out to have impact on the patients' and the relatives' daily life and how they could manage their situation. Lack of guidance and support meant insecurity, worries and distress. Cooperation in the care trajectory was found to be decisive for how well the care was running. Nurses' knowledge about tube feeding and discharge planning procedures, their commitment to the patients' care, as well as clarity regarding responsibility of HETF care were factors of crucial importance on how the cooperation worked, and the quality of the HETF care. This thesis shows the need of improvements regarding the care of HETF patients and their relatives.

No description available.

Extended hospital length of stay (LOS) causes increased health care costs and incidence of never events, such as hospital-acquired infections, pressure ulcers, and falls, which are not reimbursed by Medicare. This study examined if there would be a statistically significant decrease in the LOS of patients after the implementation of a discharge process improvement initiative (DPII), The model for improvement and small tests of change concept were used to guide the DPII at a hospital in northern California. Sources of data included archival data obtained from the hospital's quality improvement department that showed LOS prior to and after the implementation of the DPII. The LOS for 2015 and 2017 were compared using the t test for independent samples. The LOS in 2015 was longer (M = 4.59, SD = 3.66) than in 2017 (M = 4.09, SD = 3.81), a statistically significant difference, M = 0.50, 95% CI [0.32, 0.67], t (77) = 5.574, p = .005, d = 1.3, showing that the implementation of the DPII led to a reduction in the LOS. This reduction cannot be attributed solely to the DPII because other projects were implemented at the same time, such as the Clinical Decisions Unit and multidisciplinary rounds. Future research could focus on the relationship between reduced LOS and readmission and the degree of collaboration among health care team members. The implications of this study for social change include the potential to lower health care costs and increase patients' awareness of their responsibility for their own health.

Äldre och samordnad vårdplanering

The overall aim of this thesis has been to study the implementation process concerning the use of video conferencing in discharge planning, during and after a development project in a region in southeast Sweden. The research approach has been developed within a new interdisciplinary research area, Applied Health Technology. The main focus of the research has been on how the new IT solution has affected everyday work, and in what ways management supported staff during the implementation process. The study design has a qualitative approach. Phenomenological hermeneutics, content analysis and Participatory Action Research (PAR) have been used in the analysis process. Study I aimed to describe  primary healthcare nursing staff’s experiences of discharge planning, along with their concerns about using video conferencing in discharge planning sessions. It was found that there is need for improvement in communication and understanding between nursing staff working in hospitals and in primary healthcare, and need for nursing staff to obtain more information about how IT solutions could support their work. The aim of Study II was to examine the implementation process of using video conferencing in discharge planning, according to a theoretical framework composed from theories about implementation processes. It was found that implementation frameworks can be useful, and that framing the implementation process supports the exposure of factors and highlights relationships and states of dependency between those factors which may affect implementation. Study III set out to describe managers’ reflections about leading the implementation process of using video conferencing in the discharge planning session. The results indicate that managers experienced two leadership perspectives when they reflected on the implementation process. On one hand, they described a desired way of leading implementation, on the other hand they described an actual way of leading implementation. The aim of Study IV was to describe the reflections of professionals about what is needed in order to create what should become a new best practice using videoconferencing in the discharge planning sessions. The results indicate that the professionals experienced lack of knowledge and understanding about each other’s everyday work and that the absence of well-functioning common routines obstructed the process. The results also indicate that there is a lack of common arenas to enable discussions, negotiations and agreements about adopting new routines as the discharge planning process changes over time. This thesis contributes to the much-needed discussions about how to manage the many ongoing IT implementation processes in Swedish healthcare organizations, by highlighting challenges and difficulties that both healthcare professionals and managers have experienced during an implementation process. The results indicate that implementation frameworks can be useful when new IT solutions are introduced in healthcare, and that there is a need for dedicating time, space and support for involved professionals in designing their everyday work.

In today’s health care environment of quick discharges and shortened hospital stays discharge planning has become increasingly important in acute care occupational therapy practice. Discharge planning is a complex process and an important aspect of patient care as poor discharge planning has been associated with poor patient outcomes and increased risk of adverse events and readmission. This study addressed the following research questions: (a) How do acute care occupational therapists describe their role in the discharge planning process? (b) What guides acute care occupational therapists discharge decisions and recommendations? (c) How do acute care occupational therapists define optimal discharge planning? and (d) What actions can acute care occupational therapists take to optimize the effectiveness of their discharge planning skills within the current health care system? Using an action research methodology, two groups of five occupational therapists met online to discuss acute care occupational therapy discharge planning practices, and actions that could be taken to strengthen their practice. Action plans generated, implemented, and evaluated focused on improving communication with discharge planners, language used in documentation, and incorporating the use of standardized assessments to assist with discharge planning. Schell’s ecological model of professional reasoning as the theoretical model underlying this study was used to examine factors that influence occupational therapy discharge decision making. Data were collected from audio chat transcripts, survey responses, and researcher notes, and analyzed using Stringer’s action research sequential data analysis and interpretation methodology. Five themes emerged including (a) the role of occupational therapy, (b) the complexity of discharge planning, (c) pragmatics of practice, (d) why don’t they pay attention, and (e) the importance of stakeholder communication. Participants felt that discharge planners were not reading occupational therapy documentation, occupational therapy consults were late so that occupational therapy discharge recommendations were just a formality, and physical therapy discharge recommendations had more weight than occupational therapy recommendations. Participants felt that if patients were discharged without benefit of occupational therapy recommendations they could be at increased risk for an adverse event and compromised safety. Good communication among stakeholders was seen as essential for optimal discharge planning.

Bakgrund: I framtiden kommer befolkningens vårdbehov öka. För att möta detta ökade vårdbehov ställer vården om till god och nära vård. Genom utökad lagstiftning och skiftet till god och nära vård har kraven på samverkan skärpts och har även gett distriktssköterskan och primärvården en framträdande roll när det kommer till samverkan mellan vårdens olika verksamheter för patientens fortsatta vård och omsorg. Att informationsöverföringen mellan de olika vårdgivarna fungerar är en viktig del av en god samverkan och så även kommunikationen mellan sjukvårdspersonalen i de olika verksamheterna. En bristande samverkan kan leda till återinläggning på sjukhus som resulterar i risk för vårdskador och ökade kostnader för samhället. Syfte: Syftet var att belysa vårdpersonalens upplevelser av samverkan vid utskrivning av patienter från slutenvård som är i behov av insatser från primärvård. Metod: Metoden var en litteraturöversikt med systematisk ansats. Databaserna som användes för artikelsökning var PubMed, Cinahl Complete, Psych Info och MEDLINE. Femton kvalitativa originalartiklar inkluderades i resultatet. Artiklarna analyserades utifrån Burnards niostegsmetod. Resultat: Resultatet visar på tre teman med sex kategorier. Dessa teman var informationsöverföring essentiell för god samverkan, förståelse för varandras arbete för förbättrad samverkan och förändrade organisatoriska förutsättningar utmanar samverkan. Slutsats: Vårdpersonalen har både positiva och negativa upplevelser av samverkan vid patienters utskrivning från slutenvård till primärvård. Bristande informationsöverföring mellan vårdgivarna leder till att patienter inte får den vård de behöver. Personlig kontakt vårdpersonalen emellan upplevdes förbättra informationsöverföringen. Bristande förståelse för varandras roller visade sig ha en negativ effekt på samverkan. Personliga relationer över organisationsgränser visade sig däremot främja samverkan. För att starta samverkan i rätt tid efterfrågas tydliga rutiner för utskrivningsplanering inom de olika verksamheterna. / Background: In the future, the population´s care needs will increase. To meet this increased need for care, care is changing to “good and close care”. Through increased legislation and the shift to “good and close care”, the requirements for collaboration have been tightened and have also given the district nurse and primary care a prominent role when it comes to collaboration between the different care providers for the patient´s continued care. A well-working information transfer between the different care providers is an important part of good collaboration and so is communication between the health care staff in the different operations. A lack of cooperation may lead to readmission to hospital, which results in a risk of medical damage and increased costs for society. Aim: The aim was to shed light on the healthcare staff's experiences of collaboration when discharging patients from inpatient care who need interventions from primary care. Method: The method was a qualitative literature study with a systematic approach. The databases used for article searches were PubMed, Cinahl Complete, Psych Info and MEDLINE. Fifteen qualitative articles have been reviewed and analyzed using Burnard’s nine-step method. Results: The result shows three themes with six categories. These themes were information transfer essential for good collaboration, understanding of each other’s work for better collaboration and changed organizational conditions a challenge for collaboration. Conclusion: The healthcare staff have both positive and negative experiences of collaboration when patients are discharged from inpatient care to primary care. Lack of information transfer leads to patients not receiving the care they need. Personal contact between the healthcare staff was perceived to improve information transfer. Lack of understanding of each other’s roles was found to have a negative effect on cooperation. Personal relationships across organizational boundaries, on the other hand, were found to promote collaboration. To start cooperation in time, clear routines for discharge planning are requested within the different organizations.

Purpose: Healthcare organizations are mandated to improve quality and safety for patients while stressed with shorter lengths of stay, communication lapses between disciplines, and patient throughput issues that impede timely delivery of patient care. Nurses play a prominent role in the safe transition of patients from admission to discharge. Although nurses participate in discharge planning, limited research has addressed the role and outcomes of the registered nurse as a leader in the process. The aim of this study was determine if implementation of a nurse-driven discharge planning protocol for patients undergoing cardiac implant would result in improved organizational efficiencies, higher medication reconciliation rates, and higher patient satisfaction scores. Methods: A two-group posttest experimental design was used to conduct the study. Informed consent was obtained from 53 individuals scheduled for a cardiac implant procedure. Subjects were randomly assigned to either a nurse-driven discharge planning intervention group or a control group. Post procedure, 46 subjects met inclusion criteria with half (n=23) assigned to each group. All subjects received traditional discharge planning services. The morning after the cardiac implant procedure, a specially trained registered nurse assessed subjects in the intervention for discharge readiness. Subjects in the intervention groups were then discharged under protocol orders by the intervention nurse after targeted physical assessment, review of the post procedure chest radiograph, and examination of the cardiac implant device function. The intervention nurse also provided patient education, discharge instructions, and conducted medication reconciliation. The day after discharge the principal investigator conducted a scripted follow-up phone call to answer questions and monitor for post procedure complications. A Hospital Discharge Survey was administered during the subject's follow-up appointment. Results: The majority of subjects were men, Caucasian, insured, and educated at the high school level or higher. Their average age was 73.5+ 9.8 years. No significant differences between groups were noted for gender, type of insurance, education, or type of cardiac implant (chi-square); or age (t-test). A Mann-Whitney U test (one-tailed) found no significant difference in variable cost per case (p=.437) and actual charges (p=.403) between the intervention and control groups. Significant differences were found between groups for discharge satisfaction (p=.05) and the discharge perception of overall health (p=.02), with those in the intervention group reporting higher scores. Chi square analysis found no significant difference in 30-day readmission rates (p=.520). Using an independent samples t-test, those in the intervention group were discharged earlier (p=.000), had a lower length of stay (p=.005), and had higher rates of reconciled medications (p=.000). The odds of having all medications reconciled were significantly higher in the intervention group (odds ratio, 50.27; 95% CI, 5.62-450.2; p=.000). Discussion/Implications: This is the first study to evaluate the role of the nurse as a clinical leader in patient throughput, discharge planning, and patient safety initiatives. A nurse driven discharge planning protocol resulted in earlier discharge times which can have a dramatic impact on patient throughput. The nurse driven protocol significantly reduced the likelihood of unreconciled medications at discharge and significantly increased patient satisfaction. Follow-up research is needed to determine if a registered nurse can impact organizational efficiency and discharge safety in other patient populations.

No description available.