Sep 2, 2014

Hospital discharge of the elderly--an observational case study of functions, variability and performance-shaping factors

BMC Health Services Research
Kristin LaugalandJustin Waring


Understanding and improving hospital discharge has assumed major importance since it represents an error-prone transition in care. One barrier to improvement is the lack of detailed understanding of how hospital discharge is organized, including its interdependencies and influential performance-shaping factors (PSFs). This study examines the discharge of elderly patients using the Functional Resonance Analysis Method, developed to analyze performance variability in complex systems. Our main aim was to identify hospital discharge functions, variability, and PSFs that may explain the variability and different outcomes in discharge practices by incorporating multiple-stakeholder perceptions (health-care providers, patients, next of kin). The data consisted of moderate participant observations of 20 elderly patients (>75) discharged from hospital to primary health care. The data comprised 90 hours' observations at hospital wards, including 173 conversations with patients, next of kin, and health-care personnel involved in discharge. We identified 10 common functions in the discharge of elderly patients to primary health care. We found substantial variability in terms of timing, duration, and precision. Duration is a significant sou...Continue Reading

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Mentioned in this Paper

Prevalence Studies
Disability Evaluation
Patient Discharge
Observation - Diagnostic Procedure
Transcription, Medical

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