Systems and people under pressure: the discharge process in an acute hospital
Article first published online: 14 JAN 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
Journal of Clinical Nursing
Volume 18, Issue 4, pages 549–558, February 2009
How to Cite
Connolly, M., Grimshaw, J., Dodd, M., Cawthorne, J., Hulme, T., Everitt, S., Tierney, S. and Deaton, C. (2009), Systems and people under pressure: the discharge process in an acute hospital. Journal of Clinical Nursing, 18: 549–558. doi: 10.1111/j.1365-2702.2008.02551.x
- Issue published online: 14 JAN 2009
- Article first published online: 14 JAN 2009
- Accepted for publication: 26 May 2008
- discharge planning;
- hospital care;
- multiprofessional care;
- qualitative study;
Aims. To understand the perspective of hospital-based health professionals with regard to preparing patients for discharge from an acute hospital in England.
Background. The hospital experience in England over recent years is characterised by increasing admission rates and decreasing length of stay. Legislation and policy initiatives have also focussed upon the need to reduce delayed discharges. Discharge preparation is known to be a complex intervention with multiple obstacles within and outside of the hospital setting.
Methods. Posters were displayed within a hospital asking health professionals to take part in a focus group. Maximum variation, in terms of job titles, was sought for within the sample. Focus groups were held in December 2006. Six senior members of staff divided into pairs to run them. All groups were taped and transcribed verbatim and analysed using a framework approach.
Results. Three focus groups were conducted, which involved 11 nurses, 15 allied health professionals, five social workers and one doctor. Analysis identified the following themes and sub themes:
- 1Conflicting pressures on staff:
- •Keeping patients in hospital vs. getting them out;
- •Striving for flexibility within a system;
- •A paucity of intermediary provision.
- 2Casualties arising from conflicting pressures:
- •Professionals losing their sense of professionalism;
- •Patients being ‘systematised’.
Conclusions. Pressures described during focus groups stemmed from five main sources: external targets placed upon the system, internal hospital inflexibility and poor communication, the dominance of the medical model of care, a desire to address the complex needs of individuals and a lack of community services. Staff felt themselves to be victims of these competing pressures and that many of the solutions were beyond their influence. Staff described the dehumanising effect of sometimes having to ignore patient concerns, wishes and choices.
Relevance to clinical practice. Understanding of the pressures surrounding discharge could inform relevant service improvements.