While South Africa’s public health care system has come a long way since the end of Apartheid, there are still major issues preventing it from running to its full potential. We are still constantly faced by the relentless burden of infectious and non-communicable diseases, social inequalities, and the insufficient human resources to provide healthcare for the growing population (Hankey, 2017). The main focus to improve these shortcomings should be to implement strategies to improve or better staff shortages, retention of scarce resources, and ultimately, to secure the best possible care and access to healthcare services to the citizens of South Africa (Hankey, 2017). Poor service delivery, i.e waiting times to see a doctor, physiotherapist or being admitted to the ward from the emergency room is constantly found to be a long process.
We often hear medical professionals, especially doctors and surgeons, placing pressure on physiotherapists, occupational therapists and nurses to discharge the patients due to the shortage of beds, and sudden influx of patients. I encountered this in my clinical placement recently where I had been treating a 40 year old male who was day 3 post-operative above knee amputation (AKA). He lives in an apartment block where his flat is located on the 4th floor with no lift access to his floor- therefore is essential for him to be able to climb stairs before discharge. On day 2 of treatment, he managed to ambulate with 2x elbow crutches for +/- 20m, but needed slight assistance as he was not safe to walk independently and without supervision. As I arrived to treat him the following day, the doctors had written in the medical notes that patient is ‘for discharge today’. From a physiotherapist perspective, this was not ideal as he has not been taught how to ascend and descend stairs, nor was he safe to mobilize independently and as a result would not be able to access his flat. I discussed the above scenario with the sister on duty in the ward, but was told to just issue a assistive device as they urgently needed bed space in the ward. Even though the patient is medically stable to be discharged, from a rehabilitation aspect/safety of the patient he/she could benefit from staying in the hospital for a slightly longer period to ensure the patient is safe or family support has been given on how to assist the patient. The quick discharge plan was not discussed with the patient, patients family, or the multidisciplinary team (MDT)- instead just a note in the medical file reading ‘patient for discharge today’.
The focus is shifted away from the patient and his needs. Berwick (2009) describes patient-centeredness care as having 3 pillars: the needs of the patient comes first, ‘nothing about me without me’ meaning nothing is discussed about a patient without them being present, and lastly ‘every patient is the only patient’. Patient-centered care is especially important during discharge from the hospitals. The growing need for shorter hospital stays demands more post-discharge care and requires important coordinating and management role for patients and their family members to allow for this to happen. Patients at discharge are often in a vulnerable state- they are anxious, possible decreased mobility and often are experiencing increase pain (Hesselink, et al., 2012). Hesselink (2012) states that patient unpreparedness, anxiety and a misunderstanding of the situation at discharge are believed to increase hospital readmissions, which essentially acts as counteractive as the purpose of the quick discharge is top open bed space for another patient. According to Sheppard Lanin, Clemson Mcluskey, & Cameron (2013) the discharge process should ensure that patients are discharged from hospital at an appropriate time, with adequate notice and provision for other MDT’s.
In the scenario described above, I believe miscommunication between the multidisciplinary teams is the reasoning as to why the focus was shifted away from the patient,. There was no communication from the medical teams, and as a result there was no time to give the patient the best quality of care he/she deserved. It is the patients right to receive the best quality medical care from a holistic point of view and it is in the hands of the health professionals to work effectively as a multi-disciplinary team. Despite the pressure of a full waiting room, it is essential to divert all energy and focus to the patient receiving treatment and to ensure he/she is receiving the best quality of care.
References
Berwick, D. (2009, August). What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist. Health Affairs, 28(4).
Hankey, G. (2017). Patient Flow Management in a South African Academic Hospital: The Groote Schuur Hospital (GSH) Case.Cape Town: Stellenbosch University.
Hesselink, G., Flink, M., Olsson, M., Barach, P., Orrego, C., & Johnson, J. (2012). Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. BMJ(21), 39-49.
Shepperd, S., Lannin, N., Clemson, L., McCluskey, A., & Cameron, I. (2013). Discharge planning from hospital to home . Cochrane Database system review.
2 thoughts on “Quick discharges from hospitals”
Hi Michele.
Thank you for sharing your experience about the Dischrage process. Here is some feedback according to the feedback guidelines:
Content: The text reflex the topic you decided to write about and it lets me think about my own experiences about this topic at clinical placements. I have encountered the same situations at previous placements and it is an on going worry for us as health care providers.
Argument: Knowledge claims are maid and supported by references. Paragraph 2: maybe consider to include more detail about your own clinical experience and reflect more on how this situation made you think and feel. It is only vaguely described and not specific to let the reader know the exact situation/experience.
However, I like how you talk about patient-centered care and how that is important in the discharge process to prevent readmissions.
References: Good but correct reference in paragraph 2 ” (Hesselink et al., 2012)”. Also correct reference paragraph 3 “Sheppard et al. (2013)”.
Writing: The text is eqsy to read. Just some things to look at: Paragraph 1 sentence 2 change “Weare” to “we are”. Paragraph 1 sentence 3 change “toimprove” to ” to improve”.
This text made me think about how the discharge process may be from a patient’s point of view. Altough I think that in an out-patient setting or placement ,where we are involved with the discharge of a patient, we can make a difference and include them in the process and make it patient-centered.
Hi there Michele,
Thank you for sharing your writing piece regarding the debate when to discharge a patient. I am going to follow the rubric guidelines for feedback.
Context: Your topic falls within the topics we have discussed in our ethic lectures. Consider adding a picture for the reader as it may help to trigger thoughts about the writing piece and intrigue them to read it. I suggest a picture which portrays a visual image of a patient getting discharged. This will tell the reader what your writing piece is abut and intrigue them to read your piece. I feel I can relate to your topic as I have also been in this position, and since we are students, it almost feels as if we do not have the opportunity to voice our opinion.
Argument: You proposed strong arguments with good statements and reasoning. You have good referenced statements, which definitely validates what you are saying in your writing piece. Although your arguments are strong, I suggest, finding literature that deals with how other countries deals with discharging a patient? I feel this would add additional value to your writing piece.
References: You used good references and APA style for referencing.
Writing: The text is easy to read as one topic is dealt with in every paragraph. This enables the writing piece to really flows lovely. The conclusion is very good as it ends of the writing piece by linking the statements and everything ties together. I have just corrected the typo-errors in paragraph 1:
While South Africa’s public health care system has come a long way since the end of Apartheid, there are still major issues preventing it from running to its full potential. We are still constantly faced by the relentless burden of infectious and non-communicable diseases, social inequalities, and the insufficient human resources to provide healthcare for the growing population. The main focus to improve these shortcomings should be to implement strategies to improve or better staff shortages, retention of scarce resources, and ultimately, to secure the best possible care and access to healthcare services to the citizens of South Africa (Hankey, 2017). Poor service delivery, i.e waiting times to see a doctor, physiotherapist or being admitted to the ward from the emergency room is constantly found to be a long process. Residents from Mitchell’s plain have criticized the Western Cape health department for poor service delivery after many patients had to wait for more than seven hours before being seen and treated (Palm, 2018).
I really enjoyed reading this; it is also something I have been faced with numerous times and I found this topic interesting.
Well done Michele!
– Jana x