Date Presented 3/31/2017
Using action research, acute care occupational therapists explored current discharge planning practices and through consensus implemented and evaluated several strategies to improve their discharge planning skills. Increased visibility and good communication were the primary focus of the selected action plans.
Primary Author and Speaker: Helene Smith-Gabai
PURPOSE: Because occupational therapy discharge recommendations can have a significant impact on issues of patient safety, autonomy, rehabilitation potential, and quality of life, it is important to discover what occupational therapists (OTs) are currently doing, what discharge practices are successful, and which are ineffective or may be unintentionally harmful. By most accounts, discharge planning is challenging and complex, with no clear guidelines to assist therapists with the process. This study examined how acute care therapists in the United States engage in discharge planning and what approaches can improve the quality of this process. This study addressed the following research questions: How do acute care OTs describe their role in the discharge planning process? What guides acute care OTs’ discharge decisions and recommendations? How do acute care OTs define optimal discharge planning? What actions can acute care OTs take to optimize the effectiveness of their discharge planning skills within the current health care system?
DESIGN: An action research design was used consisting of two small groups of OTs meeting online to discuss their discharge planning practices and actions that could be taken to strengthen their practice. OTs working full or part time with 3+ yr of acute care experience were recruited, primarily through online methods. Data were collected from audio chat transcripts, online surveys, and researcher notes and analyzed using Stringer’s (2014) action research sequential data analysis and interpretation methodology.
RESULTS: Five themes emerged, including (1) the role of occupational therapy, (2) the complexity of discharge planning, (3) the pragmatics of practice, (4) why don’t they pay attention, and (5) the importance of stakeholder communication. Participants saw their role as being professionals, supporters of a holistic outlook, members of an interdisciplinary team, patient advocates and educators, and assessors of patients’ needs, including predictions of recovery and levels of support needed. Factors that participants saw as guiding discharge planning included internal factors related to the client, families and caregivers, and the therapists themselves, as well as external factors related to the acute care practice setting (i.e., limited time with patients, large caseloads, conflicts with productivity, reimbursement sources that limit disposition options).
Optimal discharge planning was seen as involving timely referrals, good communication, and stakeholder consensus, in which the patient receives any and all recommended and necessary services that best match the patient’s wishes and needs. However, participants also were concerned that discharge planners were not reading occupational therapy documentation, occupational therapy consults were late so that occupational therapy discharge recommendations were just a formality, and physical therapy discharge recommendations had precedence over occupational therapy recommendations, all of which were perceived as a lack of respect for occupational therapy.
In response to their concerns, the four action plans generated focused on increasing the visibility and awareness of occupational therapy in the discharge planning process through communication and language used in documentation and use of selected standardized assessments to increase the accuracy of discharge recommendations. Only the first action plan of starting a dialogue with discharge planners using the American Occupational Therapy Association’s (2017) acute care fact sheet and the third action plan of using smart phrases in documentation were deemed effective.
CONCLUSION: OTs provide a valuable service in the acute care setting but may be underutilized if others are unaware of the contributions of occupational therapy to the discharge planning process. In addition, patients can be at increased risk of a postdischarge adverse event if OTs’ recommendations are not considered.
References
American Occupational Therapy Association. (2017). Occupational therapy’s role in acute care. Retrieved from https://www.aota.org/∼/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Acute-Care.pdf
Crennan, M., & MacRae, A. (2010). Occupational therapy discharge assessment of elderly patients from acute care hospitals. Physical and Occupational Therapy in Geriatrics, 28, 33–43. http://dx.doi.org/10.3109/02703180903381060
Nalette, E. (2010). Constrained physical therapist practice: An ethical case analysis of recommending discharge placement from the acute care setting. Physical Therapy, 90, 939–952. http://dx.doi.org/10.2522/ptj.20050399
Roberts, P. S., & Robinson, M. R. (2014). Occupational therapy’s role in preventing acute readmissions. American Journal of Occupational Therapy, 68, 254–259. http://dx.doi.org/10.5014/ajot.2014.683001
Stringer, E. T. (2014). Action research (4th ed.). Los Angeles, CA: Sage.
