Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)

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

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

3

Part 1: Role development

Expert clinical

Service

developments

Practice

development

Research

development

Education, training and curriculum development

Leadership

NLD

Practice

EDD

VITAL

Pathways

Policy

Skills

GP Dis

Checklists

Process

Components of Discharge Planning ….

New roles

Assessment

Collaboration in the literature

Part 2: My Inspiration

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

Lets talk about assessment

• Assess

• Screen

• Document

• Multi-disciplinary

• Interdisciplinary

• Uni Disciplinary

• Model and transfer of?

An improvement on this !

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’

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

MOCK UP ONLY “ a tool’

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

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

Literature Review & Policy

• England

• Ireland

• Scotland

• Wales

Discharge planning: can my study make things better?

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.

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?

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?

What is the future?

• Clinical Academic Careers

• Informing the Policy

• Joint positions

Your Questions are welcomed

Liz Lees

[email protected]