Recommendations for discharge planning in community health

Abstract

Background: Patients with similar demographics and diagnoses spend varying amounts of time on community health nursing (CHN) caseloads at the discretion of individual nurses. CHNs operate with a high level of autonomy, however there are no existing guidelines related to discharging patients from community-based nursing care. The purpose of this practicum was to explore discharge planning (DP) in community health and make recommendations. Methods: An integrative literature review, key informant consultations, and chart reviews of surgical patients were conducted. Results: There was clear research evidence that DP supported by guidelines and tools can positively affect patient outcomes in a hospital setting. However, no similar studies evaluated DP in a community health context. Chart reviews revealed most surgical patients (23 – 64% depending on surgery type) were discharged after staple removal; this was considered a routine discharge. There was an average of 5-14 extra service days if the patient had a medical complication, while 24-54% of patients with no medical complications received an extra 1 - 4.3 service days with no documented explanation. Key informants stated that DP tools would be beneficial in standardizing discharge, reducing discharge variability, and supporting nurses’ assessment skills. Implications: A report of my findings and a list of discharge planning recommendations will be presented to the Community Health Nursing Program along with a sample DP checklist for frontline CHNs and a chart audit tool for community health managers.