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Risk Objective Assessment for
Discharge planning (ROAD)
Liz Lees
Consultant Nurse (acute medicine)
RGN., Dip HSM., BSc (hons)., MSc & PGR Dip.
NIHR CAT Clinical Doctorate Research Fellowship
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Todays presentation
1. My journey to this point
2. Inspiration for the research
3. About the research - assessment
4. How does this all help discharge
planning?
5. The future – clinical academic careers
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3
Part 1: Role development
Expert clinical
Service
developments
Practice
development
Research
development
Education, training and curriculum development
Leadership
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NLD
Practice
EDD
VITAL
Pathways
Policy
Skills
GP Dis
Checklists
Process
Components of Discharge Planning ….
New roles
Assessment
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Collaboration in the literature
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Part 2: My Inspiration
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Practice challenges:
Practice – the Key Issues (2014):
•Process that is transparent
•Process that works for emergency patients
•Process that works for nurses
•Estimating dates for discharge
•Increase use of Nurse Led Discharge
•Role specialisms – discharge coordination
•Competency/capability - staff on wards
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Lets talk about assessment
• Assess
• Screen
• Document
• Multi-disciplinary
• Interdisciplinary
• Uni Disciplinary
• Model and transfer of?
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Part 3: My Research
Hypothesis: The systematic use of a
standardised patient risk assessment tool
for discharge planning will improve;
‘the identification, assessment and
reassessment of patients' discharge
issues - prior to discharge; reduce failed
discharges/readmissions and lengths of
stay in hospital’
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Research Aims
To robustly develop items required for a discharge assessment tool (risk assessment/screening).
Refine the tool in line with patient experience and the hospital discharge process
Conduct small scale feasibility testing in acute practice areas.
Conduct large RCT – following above tests
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MOCK UP ONLY “ a tool’
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How? Located with epistemology - Theory of knowledge: using
Progressivism and Constructivism
Stages of item identification and tool development:
1. Literature review – evidence gap ‘discharge assessment on admission’
2. Mapping of discharge process (21 Trusts enrolled)
3. Retrospective case note analysis – failed discharges (within 30 days)
4. (a) Focus groups with staff – perception of risk assessment
4. (b)PPi (PCPiE) or interviews with patients experienced failed discharge
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Analy
sis
Allo
catio
n
Enro
lment
Control
Usual process
Intervention
Risk assessment
Feasibility tests
Acute medicine unit (84 beds)
Inclusion criteria:
Decision to admit
patient
LOS up to 5 days
Able to participate in
assessment on
admission
Exclusion criteria:
Patient due to be
discharged from AMU
Patient clinically unstable
End of life
Cognitively impaired &
presents to AMU alone
Outcome measures:
1. Reduction in length of stay: ratio data (hours/days) Mann Whitney
2. Reduce failed discharges: (at categorical level) – Chi-squared
3. Improve patient involvement: - Survey instrument
4. Evaluate staff perceptions of risk assessment tool: -Focus Groups
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Literature Review & Policy
• England
• Ireland
• Scotland
• Wales
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Discharge planning: can my study make things better?
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As a Scholar
That discharge planning has become a
managed activity which has far too much
emphasis on ‘the organisation’ and ‘beds’
and ‘capacity’ than actual patient and
carer needs to form a realistic discharge
plan.
We must focus upon assessment skills.
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The research questions
(background)
1.Does a risk assessment tool aid the identification of risks
for patients entering hospital via emergency care?
2.Will a risk assessment be conducive for use by staff
within emergency care?
3.What are the types of risk or predictive assessments
used related to discharge planning – wider topics such as
readmission prediction?
4.How will a discharge risk assessment align with other
assessments being undertaken for discharge planning – by
other professionals?
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Research questions
(foreground) • What are the items of risk required on a discharge risk
assessment tool?
• Who will be the key professionals to use a discharge risk
assessment tool?
• Would a risk assessment tool aid the sharing of
information amongst different professionals involved in
the discharge planning?
• Would the early identification of risks reduce time lags in
the usual process between identification of risks and
actions (referrals etc)?
• Where does a risk assessment fit within the current
process of discharge planning from hospital?
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What is the future?
• Clinical Academic Careers
• Informing the Policy
• Joint positions