liz lees, nihr - road - getting patients on the right road to discharge from hospital: risk...
Post on 14-Sep-2014
423 views
DESCRIPTION
Liz Lees, Clinical Doctoral Research Fellow, National Institute for Healthcare Research (NIHR) & Consultant Nurse in Acute Care delivered the presentation at the 2014 Discharge Planning Conference. The 2014 Discharge Planning Conference assisting health services to adopt an integrated and consumer directed approach to discharge planning. For more information about the event, please visit: http://bit.ly/dischargeplan14TRANSCRIPT
![Page 1: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/1.jpg)
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
![Page 2: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/2.jpg)
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
![Page 3: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/3.jpg)
3
Part 1: Role development
Expert clinical
Service
developments
Practice
development
Research
development
Education, training and curriculum development
Leadership
![Page 4: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/4.jpg)
NLD
Practice
EDD
VITAL
Pathways
Policy
Skills
GP Dis
Checklists
Process
Components of Discharge Planning ….
New roles
Assessment
![Page 5: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/5.jpg)
![Page 6: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/6.jpg)
Collaboration in the literature
![Page 7: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/7.jpg)
Part 2: My Inspiration
![Page 8: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/8.jpg)
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
![Page 9: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/9.jpg)
Lets talk about assessment
• Assess
• Screen
• Document
• Multi-disciplinary
• Interdisciplinary
• Uni Disciplinary
• Model and transfer of?
![Page 11: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/11.jpg)
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’
![Page 12: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/12.jpg)
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
![Page 13: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/13.jpg)
MOCK UP ONLY “ a tool’
![Page 14: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/14.jpg)
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
![Page 15: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/15.jpg)
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
![Page 16: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/16.jpg)
Literature Review & Policy
• England
• Ireland
• Scotland
• Wales
![Page 17: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/17.jpg)
Discharge planning: can my study make things better?
![Page 18: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/18.jpg)
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.
![Page 19: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/19.jpg)
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?
![Page 20: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/20.jpg)
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?
![Page 21: Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)](https://reader034.vdocuments.us/reader034/viewer/2022051311/5415d58e8d7f722f6c8b484f/html5/thumbnails/21.jpg)
What is the future?
• Clinical Academic Careers
• Informing the Policy
• Joint positions