Understanding, exploring and reviewing emergency department discharge processes: Insights from interviews with patients and clinicians

Prof. Margaret Fry1, Leahanna Stevens2, Michael Browne3, Arthrit Barnes2

1University of Technology Sydney / NSLHD, Sydney, Australia, 2Mersey Hospital , Tasmania, Australia, 3Hobart Hospital , Hobart, Australia

Timely patient discharge is important to ensure patient flow is optimised, resources are appropriately allocated and capacity for treating new patients is available in the emergency department. Equally important is discharge planning to ensure the safe transition and or transfer of care thereby preventing harm to patients, avoidable representations and low compliance.

The discharge process involves communication of healthcare information to optimise patient safety, self-management, and understanding and compliance with ongoing treatment. Across Australia there is no evidence of how discharge planning should be conducted in ED; the role of the emergency team in discharge planning; or expectations of discharge and the key issues for emergency clinicians that impact on transition of care. Therefore, the aim of this study was to explore perceptions and experiences in and of ED discharge planning processes with patients and clinicians.

Method: The design was a qualitative descriptive study. Data collection involved telephone and face to face interviews with emergency clinicians and patients.

Results: Patient interviews (n=100) identified that the majority (93%) of patients understood their ED treatment, were confident to be discharged home (88%), and satisfied (90%) with ED care. The majority of patients’ understood their discharge diagnosis (86%) and were  provided with verbal (84%) discharge information. Discharge referral instructions were followed up by 60% of patients with 26% of patients re-presenting to ED.  The key themes to emerge from the face to face clinician interviews (n=21) were: 1) managing emergency department discharge processes; 2) working as a team and communication; 3) safe discharge and an enabling environment.

Conclusion: The study highlighted that the majority of patients were satisfied with ED care, complied with discharge healthcare information and confident to be discharged. However, clinicians emphasised a more systematic approach to ED discharge is needed to maximise safety, consistency, compliance and understanding of health information.


Biography:

Professor Fry is the Nursing and Midwifery Director Research and Practice Development for Northern Sydney Local Health District which is a conjoint Professorial Chair position with the University of Technology Sydney. She is also an adjunct professor with the School of Nursing University of Sydney. Professor Fry has 25 years emergency experience as a Clinical Nurse Consultant and authorised Nurse Practitioner (NSW).  Professor Fry has extensive emergency nursing experience and a proven research track with 137 peer reviewed publications and over $2.9million in grant, research tenders and or scholarship funding. Professor Fry’s program of emergency care research has established her as a national and international leader with strong clinical credibility. She has been involved, as Chief Investigator, in numerous research projects in emergency care evaluation, advanced nursing practice, and pain management and has undertaken significant workforce health services and practice research. Her program of research has led to significant Australian state and national emergency nursing practice change. Her recent program of research involves pain management, emergency care service utilisation, effective models of care, advanced nursing practice, the use of care bundles to support patient outcomes, and emergency discharge processes. In the acute in-hospital environment, she is working on interventions to reduce the occurrence of hospital acquired complications and representations