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New research shows deficits in discharge planning

Published: 20 April 2016

Discharge planning is a complex process that aims to secure the patients’ care transition from home to the hospital and back home. New unique research shows that there are hindrances on different organizational levels that affect the process workflow, which can lead to negative consequences for the patient.

– This process was implemented over ten years ago, but it's still not normalized in everyday work. Health and social care personnel had reached a consensus on what the process was about (coherence) and how they evaluated the process (reflexive monitoring), but not on who performed the process (cognitive participation), and how it was performed (collective action), says Sofi Nordmark, researcher in Nursing at the Luleå University of Technology.

The aim of the study was to gain a broader knowledge about the whole discharge planning process by exploring the experiences of registered nurses, district nurses and homecare organizers both before and after the development and testing of various Information and Communication Technology (ICT) solutions.

Ministry of Social Affairs has taken note of Sofi Nordmark research material in their preparatory work for a new law in the area, which will enter into force in 2017.

Delays in information exchange

Central to the discharge planning is collaboration and information exchange between health care providers and patients/relatives. Studies show that deficits in the process, like delays and gaps in collaboration and information exchange, can negatively affect the patient with delayed discharge, readmission, inadequate post discharge care, and reduced quality of life.

– When the care providers are not in phase with each other, the discharge planning will be fragmented. The patient does not get a cohesive plan based on their preferences and needs, and it becomes difficult for the patient to take an active role and be involved in the planning, says Sofi Nordmark.

The studies show that demands, workload, time, collaboration, engagement together with knowledge and professional confidence were factors that influenced the discharge planning. Hindrances and feasibilities that affected the workflow occurred at organizational-, group and individual level.

Agile development work

To support the discharge planning ICT solutions was tested and developed led by Sofi Nordmark. In this work, she has been using an agile inspiring development process. It means that the dialogue between IT developers and end users, that is registered nurses, district nurses and homecare organizers are the backbone of the development process. A continuous communication between developers and end users with fast and small demo delivers of the ICT solutions during the development process was important and allowed changes through the process. The agile process also meant that the three different groups of personnel met in workshops several times and had the opportunity to discuss the difference in the perception of who is doing what and how.

– Then an understanding for each other's roles and responsibilities was reached, and as a side effect of the ICT development an increased transparency with a better understanding of each other's roles and improved collaboration was reached, says Sofi Nordmark.

The studies show that the potential risk of a failure of a sustainable implementation is the lack of time and timing on organizational-, group- and individual level, but also between these levels.

Unique research

The studies are performed in Norrbotten, but literature from other Western countries shows that everyone has problems with gaps and deficits in the information exchange and collaboration. There are many studies made in the area, but only the sub-processes have been studied. Therefore are Sofi Nordmarks’ research world-unique because she looked at all the sub-processes in the entire flow and from three different perspectives; hostpital-, primary care- and municipality.

Research right in time

Late this spring, a proposition will be made and in the autumn 2017 a new law will enter into force, where the law on municipalities' liability for certain health care becomes the law on collaboration at discharge from inpatient care.
– It means a great change and increased demands on the efficient information echange and collaboration between and within the various organizations, where the individual's role also is strengthened.

Nationally, Sofi Nordmarks’ research is coveted by many municipalities that are poised for major development in terms of ICT solutions to increase patient and user participation and adaptation to the new legislation.

Project with the law in focus

From March the 1, Sofi Nordmark took a new position as a project manager in a large collaborative project between the Norrbotten County Council, Association of Municipalities of Norrbotten and Luleå University of Technology, where the municipalities of Luleå and Haparanda are pilots. The Swedish Agency for Economic and Regional Growth approved the project Available coordinated individual plans, which runs from January 1, 2016 to December 31, 2018, over SEK 23 million from the European Regional Development Fund. Within the project, changes in working methods and collaboration agreement will be prepared based on the new legislation. Even a new IT support and e-health solutions will be implemented and the health and social care plan will be made available to the individual as a service for residents through 1177 Healthcare Guide.