Ms Jen McKenzie1, Ms Nicola Farrer, Ms Stephanie Dunstall
1MLHD, WAGGA WAGGA, Australia
Abstract:
Background:
Post restructure into a district wide specialist palliative care service, demand on the service grew exponentially. Rapid growth in patient numbers and increased geographical spread led to unreasonable workloads and clinical risk.
Aims:
To develop a method of safe discharge for palliative care patients deemed to be stable for a prolonged period of time and to ensure patients that are discharged have had their care goals achieved and are aware of the process of re-admission.
Method:
Initial methods to review clinical lists and discharge patients deemed stable was ad hoc and applied inconsistently. Timing of discharges, minimum care standards and messaging around the discharge was erratically applied. Clinicians while supportive of aims of discharge, expressed dissatisfaction with the process and fear of poor patient outcomes. A review of literature was attended and information on work practices around discharges sought from other districts. This formed the foundation for a quality improvement project for one of the author’s coinciding with policy development to standardise and formalise the discharge process for stable patients.
Results:
Palliative care clinicians were surveyed for consensus on timing of discharge and key goals of care to be completed with our palliative care patients and carer’s established. Standardised information sheets for returning to service, letters to referrers and key goals of care have been developed. Education for palliative care and other community-based care clinicians developed and scripts for positive language round discharge formulated. To ensure all members of interdisciplinary team are aware of discharge a fortnightly discharge meeting has been established and a template for care outcomes created as a communication tool.
Results:
Discharge of stable patients is applied consistently across the district. Prior to discharge patients have key goals reviewed and information provision for readmission. Clinician satisfaction with discharging patients has improved.
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