Situational Analysis of Discharge Planning at the Emergency Department in a Tertiary Hospital in Southern Thailand

Abstract

Discharge planning for emergency department patients is an important nursing activity that helps patients manage their health at home with confidence and safety after being discharged from the emergency department. This qualitative study aimed to analyze the structure, process, and outcomes of discharge planning in the emergency department based on Donabedian’s Quality Assessment framework and Lynn et al.’s discharge planning process. The data were collected from 18 informants, including head nurses and emergency department nurses, through semi-structured interviews and focus group discussions, and were analyzed using content analysis.

The research showed:
1. Structure: the study found that the hospital has a policy to promote discharge planning, but the head nurse of the emergency department’s communication of the policy was unclear and not widespread. As a result, some nurses are not aware of the discharge planning principles and, therefore, are not able to implement them comprehensively. Nurses use nursing records as tools to communicate patient care information, along with verbal communication. Health knowledge pamphlets are provided to patients and caregivers for their further study at home. Due to varying levels of experience among nurses, this results in varied approaches to discharge planning and a lack of consistency in the provision of information, knowledge, and recommendations.
2.  Process: the study found that nurses begin discharge planning when a doctor orders the patient to be discharged. Nurses assess the patient's problems and care needs in some cases, and plan the discharge with the patient and caregiver. Nurses provide consultations, and teach, demonstrate, and train the patients and caregivers in the necessary skills, but the completeness of the content varies depending on the nurse’s knowledge and experience. The evaluation is conducted through return demonstrations or verbal explanations, but there is no clear guideline, leaving it up to the nurse's discretion.
3. Outcome: the study found that no quality indicators related to discharge planning have been established. While revisit data is collected, no data analysis has been conducted yet.

The results of this study can be used by nursing administrators as a basis for improving discharge planning in the emergency department and for developing an appropriate discharge planning model for emergency department use in the future.