Risk Objective Assessment for
Discharge planning (ROAD)
Liz Lees
Consultant Nurse (acute medicine)
RGN., Dip HSM., BSc (ho...
Todays presentation
1. My journey to this point
2. Inspiration for the research
3. About the research - assessment
4. How ...
3
Part 1: Role development
Expert clinical
Service
developments
Practice
development
Research
development
Education, train...
NLD
Practice
EDD
VITAL
Pathways
Policy
Skills
GPDis
Checklists
Process
Components of Discharge Planning ….
New roles
Asses...
Collaboration in the literature
Part 2: My Inspiration
Practice challenges:
Practice – the Key Issues (2014):
•Process that is transparent
•Process that works for emergency pati...
Lets talk about assessment
• Assess
• Screen
• Document
• Multi-disciplinary
• Interdisciplinary
• Uni Disciplinary
• Mode...
An improvement on this !
Part 3: My Research
Hypothesis: The systematic use of a
standardised patient risk assessment tool
for discharge planning w...
Research Aims
To robustly develop items required for a discharge
assessment tool (risk assessment/screening).
Refine the t...
MOCK UP ONLY “ a tool’
How?
Located with epistemology - Theory of knowledge: using
Progressivism and Constructivism
Stages of item identification...
Analysis
AllocationEnrolment
Control
Usual process
Intervention
Risk assessment
Feasibility tests
Acute medicine unit (84 ...
Literature Review & Policy
• England
• Ireland
• Scotland
• Wales
Discharge planning:
can my study make things better?
As a Scholar
That discharge planning has become a
managed activity which has far too much
emphasis on ‘the organisation’ a...
The research questions
(background)
1.Does a risk assessment tool aid the identification of risks
for patients entering ho...
Research questions
(foreground)
• What are the items of risk required on a discharge risk
assessment tool?
• Who will be t...
What is the future?
• Clinical Academic Careers
• Informing the Policy
• Joint positions
Your Questions are welcomed
Liz Lees
lizlees@aol.com
Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Disch...
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Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)

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Liz Lees, Clinical Doctoral Research Fellow, National Institute for Healthcare Research (NIHR) & Consultant Nurse in Acute Care delivered the presentation at the 2014 Discharge Planning Conference.

The 2014 Discharge Planning Conference assisting health services to adopt an integrated and consumer directed approach to discharge planning.

For more information about the event, please visit: http://bit.ly/dischargeplan14

Published in: Health & Medicine
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Liz Lees, NIHR - ROAD - Getting patients on the right road to discharge from hospital: Risk Objective Assessment for Discharge (ROAD)

  1. 1. Risk Objective Assessment for Discharge planning (ROAD) Liz Lees Consultant Nurse (acute medicine) RGN., Dip HSM., BSc (hons)., MSc & PGR Dip. NIHR CAT Clinical Doctorate Research Fellowship
  2. 2. Todays presentation 1. My journey to this point 2. Inspiration for the research 3. About the research - assessment 4. How does this all help discharge planning? 5. The future – clinical academic careers
  3. 3. 3 Part 1: Role development Expert clinical Service developments Practice development Research development Education, training and curriculum development Leadership
  4. 4. NLD Practice EDD VITAL Pathways Policy Skills GPDis Checklists Process Components of Discharge Planning …. New roles Assessment
  5. 5. Collaboration in the literature
  6. 6. Part 2: My Inspiration
  7. 7. Practice challenges: Practice – the Key Issues (2014): •Process that is transparent •Process that works for emergency patients •Process that works for nurses •Estimating dates for discharge •Increase use of Nurse Led Discharge •Role specialisms – discharge coordination •Competency/capability - staff on wards
  8. 8. Lets talk about assessment • Assess • Screen • Document • Multi-disciplinary • Interdisciplinary • Uni Disciplinary • Model and transfer of?
  9. 9. An improvement on this !
  10. 10. Part 3: My Research Hypothesis: The systematic use of a standardised patient risk assessment tool for discharge planning will improve; ‘the identification, assessment and reassessment of patients' discharge issues - prior to discharge; reduce failed discharges/readmissions and lengths of stay in hospital’
  11. 11. Research Aims To robustly develop items required for a discharge assessment tool (risk assessment/screening). Refine the tool in line with patient experience and the hospital discharge process Conduct small scale feasibility testing in acute practice areas. Conduct large RCT – following above tests
  12. 12. MOCK UP ONLY “ a tool’
  13. 13. How? Located with epistemology - Theory of knowledge: using Progressivism and Constructivism Stages of item identification and tool development: 1. Literature review – evidence gap ‘discharge assessment on admission’ 2. Mapping of discharge process (21 Trusts enrolled) 3. Retrospective case note analysis – failed discharges (within 30 days) 4. (a) Focus groups with staff – perception of risk assessment 4. (b)PPi (PCPiE) or interviews with patients experienced failed discharge
  14. 14. Analysis AllocationEnrolment Control Usual process Intervention Risk assessment Feasibility tests Acute medicine unit (84 beds) Inclusion criteria: Decision to admit patient LOS up to 5 days Able to participate in assessment on admission Exclusion criteria: Patient due to be discharged from AMU Patient clinically unstable End of life Cognitively impaired & presents to AMU alone Outcome measures: 1. Reduction in length of stay: ratio data (hours/days) Mann Whitney 2. Reduce failed discharges: (at categorical level) – Chi-squared 3. Improve patient involvement: - Survey instrument 4. Evaluate staff perceptions of risk assessment tool: -Focus Groups
  15. 15. Literature Review & Policy • England • Ireland • Scotland • Wales
  16. 16. Discharge planning: can my study make things better?
  17. 17. As a Scholar That discharge planning has become a managed activity which has far too much emphasis on ‘the organisation’ and ‘beds’ and ‘capacity’ than actual patient and carer needs to form a realistic discharge plan. We must focus upon assessment skills.
  18. 18. The research questions (background) 1.Does a risk assessment tool aid the identification of risks for patients entering hospital via emergency care? 2.Will a risk assessment be conducive for use by staff within emergency care? 3.What are the types of risk or predictive assessments used related to discharge planning – wider topics such as readmission prediction? 4.How will a discharge risk assessment align with other assessments being undertaken for discharge planning – by other professionals?
  19. 19. Research questions (foreground) • What are the items of risk required on a discharge risk assessment tool? • Who will be the key professionals to use a discharge risk assessment tool? • Would a risk assessment tool aid the sharing of information amongst different professionals involved in the discharge planning? • Would the early identification of risks reduce time lags in the usual process between identification of risks and actions (referrals etc)? • Where does a risk assessment fit within the current process of discharge planning from hospital?
  20. 20. What is the future? • Clinical Academic Careers • Informing the Policy • Joint positions
  21. 21. Your Questions are welcomed Liz Lees lizlees@aol.com

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