Discharge planning in a tertiary hospital in KwaZulu-Natal : views of multidisciplinary team members.

Abstract

Discharge planning is an integral part of patient care, which involves the transfer of patients from the hospital to the community, taking into account the patient’s unique and complex needs. However, this process is often fraught with complexities. This study was designed to explore challenges of current practices in discharge planning and to establish factors and effective strategies for future management. A qualitative and descriptive study was undertaken to understand the views of health care professionals on discharge planning within a tertiary hospital setting in KwaZulu-Natal. A comprehensive, rather than a disease-specific approach was used. Systems theory and the bio-psycho-social model formed the appropriate theoretical framework for the current study, which considered a holistic approach, taking into account systemic factors, relationships, physical, psychological and social aspects of patient care. Purposive sampling was used to identify 26 members of the multidisciplinary team with the relevant knowledge and experience. Semi-structured interviews, that were audio-recorded, were undertaken as the primary method of data collection, from which transcripts were thematically analysed. The study identified the key themes in terms of major challenges that included inter-hospital transport and referrals, resource constraints, patient compliance, and caregiver preparedness. The poor socio-economic circumstances of patients and their families formed a grim background. A documentation analysis of discharge summaries, utilized as a secondary method for the purposes of triangulation, revealed inconsistencies in the discharge summary system that varied between incomplete or well written reports. Based on the study findings, recommendations are made in respect of practice, policy and further research in the designated area of study. Some of the strategies recommended include collaboration with the multidisciplinary team, improving patient and caregiver education and establishing a formalized system of discharge planning, policies and discharge summaries.