Discharge Planning and Coordination
Discharge planning is critical for improving the patient care hence increasing the ability of patient to fully recover after discharge from the healthcare facility. The relapse prevention remains important in patient care as many patient may increase the health burden due to relapse. This implies that relapse prevention reduces any probability of adverse event occurring after successful treatment of patient. There are many relapse prevention methods and processes yet relapse may still occur despite the prevention method. A coordination of healthcare between professionals post hospital stay between the healthcare and community enable improvement of patient care hence prevention of deterioration of patient care. There many different strategies that enable discharge planning and coordination of discharge process to prevent relapse. The main focus of this paper is relapse prevention by following discharge flowchart especially the strategies involved. The prevention of relapse by following discharge flowchart requires understanding of various issues that from part of the discharge planning process. This also involves reduction of risk occurring in the event of patient discharge is not properly coordinated. Evaluation strategies is also part of discharge planning that consider evaluation of risk involved, risk reduction method and ethical practice required.
The relapse prevention following discharge flowchart is project that seek to improve coordination of healthcare practice after discharge from the medical health facility. The project involves discharge planning and coordinating activities to prevent the likelihood of relapse occurring in the life of elderly patients (age ≥65) discharged from a psychiatric hospital to community. This project will seek to improve the discharge process by improving communication, reducing risk of readmission into the hospital hence reduce hospital workload. The project aim to introduce a coordinated follow-up activity running for 7 days, readmission prevention method and approval of the project from in-principle (Chartered Management Institute 2020).
Figure 1: Discharge flowchart
The Australian Commission on Safety and Quality in Health Care provides guidelines for communication between health professionals. Communication remains an important aspect of medical practice as communication ensures that all information are passed from one person to another. The project brings out certain communication strategies that will ensure that objectives of the project are met. Firstly, flowchart communication that summarizes the whole discharge process step by step. Flowchart has been used in medical practice to document some critical steps of medical procedure. Discharge planning and process is a long process that requires standards of communication. The flow chart will summarize all the patient information and planed medical care up to discharge point. This flowchart will be used to communicate to other health stakeholders on the need to pass down crucial information from the health facility to the community (Government of Western Australia East Metropolitan Health Service 2020).
Secondly, transfer of care summary (TOCS) is communication tool developed by the project team with aim of transferring care summary from hospital facility care giver to community care giver. Transfer of care summary is document developed to capture summary of care when patient was admitted all the type of care provided to the patient. This transfer of care summary is developed with constancy of requirement from Agency for Clinical Innovation (ACI), which redesign and evaluate innovation within healthcare. This will also include the medical history of the patient that assist in prevention of relapse from psychiatric patients. Also contained within the transfer of care summary is follow up part that assists health professionals to identify and conduct follow up for patients. Furthermore, the transfer of care summary contain 7/7 follow up section by inpatient clinician after patient has been discharged (Gabriel et al. 2017). This are necessary for tracking down patients that need follow up after treatment and discharge from the hospital. Some of the items to include in the transfer of care summary are listed in the figure below.
Communication Strategies
Figure 2: Transfer of Care (TOCS)
Risk management in project is another area that need deeper consideration to enable project delivery. There are some steps that enable resolving risk within project. Firstly, risk documentation that includes risk description, probability of risk occurring, risk owner, response and the impact of risk. This enables elaborate understanding of risk before or after risk occurrence. Secondly, identification of the types of risk that might occur during the project delivery is another step. Project team can ask stakeholders about their concerns about the project to help identify any type of risk. Thirdly, determination of the probability of risk, impact and response which help determine the likelihood of this risk occurring. The impact of risk on the project and response through resolving risk is also determined at this time. Fourthly, project risk owner, estimation and review of the risk are conducted during and after implementation of this project. Minimizing risk will help to save on the cost of the implementation of the project hence completion within the timeline set (Christ, Clarkin & Hull 2019).
Risk remediation involves certain steps and processes that include risk avoidance, transference, acceptance and limit. Firstly, risk avoidance is avoiding risk at all cost and this can be done through risk management steps. Secondly, transfer of risk is also necessary to prevent the cost attributed to risk. Lastly, limiting the risk that come as result of reduction of the likelihood of the risk occurring (Dionne 2013).
Addressing timeline excessive
Timeline excessive refers to the situation where the timeline is delayed due to some challenges leading to project delay completion. This can be managed through planning and confinement on the project plan and timeline. Project plan and timeline provide the guideline for implementation and time. This need to be followed to prevent excessive timeline especially where risk that could be avoided delays the project (Dillon 2018).
Ethical issues and addressing ethical issues
There are some ethical issues that are most likely to affect the project implementation. Firstly, compliance with guideline set by the ministry of health of Australia may require strict usage of the standards set by the ministry. This might affect the project during implementation within the healthcare. Secondly, approval of the project is another ethical issues that is most likely to come up during the implementation of the project. The team will have to seek in-principal approval before the project can be implemented within the health care setting. All medical staff are expected to follow guideline and the ministry of health will have to approve the project deliverable such as transfer of care summary before used. This implies that medical staff will be required to implement only what is approved by ethical team. Ethical team might lead to delays and excessive timeline of the project leading to loss of large amount of money. One of the concerns that might rise from the project is the safety as this becomes the primary goal of the healthcare project. The project is safer for usage by the medical staff both at the hospital and at the community level (Kudyba 2021).
Risk Management
Potential project costs and budget are identified and explained
The project will cost $100,000 for department project expenses and project risks and constrains need to be reduced to ensure that project cost and budget are protected. All people that are involved in the project need to reduce any unnecessary wastage of resources to ensure that project costs are achieved without limitation. According to Shepperd (2013), project cost may be overstretched due to some risk which can be avoided or reduced.
The project evaluation involves all stages of the project that is ranging from problem identification and assessment stage to project completion. The project evaluation strategies that will be used in the project include a number of issues. The project evaluation will be based on the type of evaluation that is being conducted and the evaluation process. The evaluation strategy that will be used in the project is integration of various types of evaluation. There are some types of evaluation that will be conducted within project to ensure that it success (Department of Health 2015).
Process evaluation
Process evaluation is the evaluation that is conducted to determine the effectiveness of the process being followed. The process evaluation will be conducted to ensure that the recommended process is followed especially following the flowchart. Process and procedures are key aspects of health care and following process or procedure is essential. The project will be align the discharge flowchart with discharge planning. This alignment need to be followed to ensure that all steps are followed for effective prevention of relapse. This implies that all team members that are involved in discharge process will have to follow the process to ensure all are captured. Evaluation will be conducted through evaluation form where professionals record all steps followed together with feedback from their experience (McGivern & Fischer 2012).
Impact evaluation
Impact evaluation is the evaluation that involves assessment of the impact of the project on stakeholder or organization. The impact of relapse prevention following flow chart will be done at every stage of the discharge planning. This will ensure that stakeholders give their assessment at every stage to identify the impact of these stages on the life of stakeholders. For instance, patient will give feedback from service rendered. This will make the whole process to be involving for all stakeholders. Moreover, clients and medical staff will also give their feedback from the process to ascertain the impact of the process. The data collected from these stakeholders will be evaluated for decision making. The impact assessment or evaluation will be conducted through survey and feedbacks where all people involved in the process give their opinion about the process.
Summative evaluation
Summative evaluation is another evaluation that will be conducted through summary of all activities in report. This type of evaluation is conducted at the end of the project and focuses on the project completion. The summative evaluation is done after implementation of the project that takes into consideration various steps of the project ranging from the project planning to project implementation. This summary will be used by the project team to report to the management on the project. In addition, the project team will also capture all stages of the flowchart as was used within the project. This will enable reporting of the summary of the process aiming at prevention of relapse among aged patient. Summative evaluation will also be done at the end of every patient discharged and transfer of care summary given (Healthdirect 2022).
Ethical Considerations
Feedback loop
Feedback loop is an evaluation tool that collects feedback from users of the system and the assessment of the system. There are many different users across the discharge process that are all linked together and collection of feedback from these users enable identification of challenges and risk that might be associated with the project. Moreover, the medical staff is encouraged to work in collaborative to provide high quality of care. Feedback loop should be fitted throughout the discharge process. This is to ensure that every step of the discharge process is followed according to set standards. Feedback also shows the level of satisfaction among key stakeholders such as patients and medical staff. Feedback loop offers opportunity for the project implementation team to evaluate each stage to identify all steps that might affects the whole implementation process. This is essential for reporting to the management of the facility on the level of success and areas that need improvement (Wilkinson & Harper 2020).
Key performance indicators (KPI)
There are some key performance indicators (KPI) that can be used to evaluate the project after implementation. Firstly, reduced number of hospital readmissions is another key performance indicator that will be used to evaluate the project. The number of readmission within the first 28 days post discharge will show the performance of the project. Secondly, the number of discharges where the project has been used to prevent relapse are key performance indicator. During discharge planning and implementation the flowchart and TOCS will be used and this implies that the number of discharge with also correspond to the number of successful use of the project. Thirdly, the number of TOCS that has been written and passed down to community health professionals will determine that success of the project. In addition, the TOCS will serves as point of connection between two types of care givers one within hospital while another in the community. Lastly, the number of patients that has been discharged using the flowchart and TOCS. This number will directly show that number people that are already benefited from the project. The number patients that have used the system are used in evaluation process to bring about change (Able Australia 2020).
Figure 3: Improved discharge flowchart
Collection of usage information
Collection of the usage information will be conducted in a number of ways and these include feedback and surveys. Firstly, feedback from stakeholders will be collected for analysis to establish the risk that might be available during the project implementation. There are forms that will be signed by those using transfer of care summary during discharge. This will come along with section of comment meant to collect user feedbacks. Secondly, surveys will also be used to collect information on the process and used to evaluate the project. This will enable the project team to collect data from users especially the medical team on the effectiveness of the project hence its success. This will also help the team to conduct assessment of risk and overall project evaluation according to project objectives. Collection of information can also be done from the client side where patients can be evaluated on the relapse prevention (Dwyer, Liang & Thiessen 2019).
Standards and guidelines that project is aligned to
The project is aligned with many standards outlined by the ministry of health NHS. Firstly, the project is aligned to Australian Commission on Safety and Quality in Health Care that defines safer communication between health professionals. Secondly, the project is aligned to Agency for Clinical Innovation (ACI) that provides guidelines for innovation in healthcare. Thirdly, the project is aligned with National Safety and Quality Health Service (NSQHS) which safeguard the quality and safety of patient and medical professionals within Australia. This agency evaluate various practice and also provides the standard of care to all the health stakeholders. Nursing guidelines and standards of practice will also be used in project as taking care of aged people requires conforming to the nursing standards. This will enable safer and quality of care is assured throughout the discharge process (Australian Commission on Safety and Quality in Healthcare 2017).
Comprehensive assessment
The comprehensive assessment will be conducted through evaluation of various health professionals. Comprehensive assessment will be conducted through multidisciplinary approach that involves many different health practitioners. These include the nursing practitioners, physicians, allied health professionals and consultation with consumer. Allied health professionals such as physiotherapist will evaluate the patient after discharge to ensure that patient is fit for discharge and after discharge. Interview of patient’s families will also be conducted to ascertain the clinical outcomes of patient. Moreover, aged care assessment by aged care assessment team will be conducted within the aged care facilities to determine the patient outcome.
Conclusion
In conclusion, discharge planning is essential for prevention of relapse among the aged patients with psychiatric needs. Relapse prevention by following discharge flowchart offers an opportunity for the healthcare providers to coordinate care after discharge of patient from healthcare facility. There are many different strategies that are involved in discharge planning especially risk prevention strategies, communication strategies and evaluation strategies for the whole project. Communication strategies involved in the project focuses on the user of discharge flowchart and transfer of care summary for coordinating of activities between health professionals. There are many different risk management strategies that enable reduction or resolving the risk that might occur during discharge planning process.
Reference
Able Australia (2020) Services for Seniors, Dowsing Point, Hobart, available at https://ableaustralia.org.au/about-us/locations/.
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Dwyer, J., Liang, Z. & Thiessen, V. (2019) Project management in health and community services: getting good ideas to work, 3rd edition., Allen & Unwin, viewed 29 March 2022, <https://search.ebscohost.com/login.aspxdirect=true&db=cat02831a&AN=UTas.b2905808&site=eds-live. [Accessed 23, April 2022]
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