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Making evidence fit for purpose in decision making: a case study of the hospital discharge of older people
- Authors:
- GLASBY Jon, WALSHE Kieran, HARVEY Gill
- Journal article citation:
- Evidence and Policy, 3(3), August 2007, pp.425-437.
- Publisher:
- Policy Press
This article focusing on a case study topic (hospital discharge), participants were provided with six sources of evidence chosen to illustrate six very different approaches to generating valid knowledge. Participants then explored a series of questions about each (including reliability/validity, key limitations and contributions to new knowledge). Overall, none of the sources was felt to offer a definitive insight into the issue at stake. A key challenge, therefore, is to design deliberative processes to synthesise and integrate evidence of different types and from multiple sources.
Moving on? A handbook on modelling the whole system for delayed discharges in Tayside
- Author:
- AUDIT SCOTLAND
- Publisher:
- Audit Scotland
- Publication year:
- 2005
- Pagination:
- 24p.
- Place of publication:
- Edinburgh
During 2004 Audit Scotland led a project with the Tayside Partnership and ISD to develop a whole systems model for Tayside to help tackle its delayed discharges from hospital. This handbook aims to share this approach with Scotland’s NHS and council partnerships wishing to develop their own whole systems thinking. The Tayside model does not provide a solution to the problem of delayed discharges in Tayside. It is an interactive tool to inform and help planning and decision-making in relation to delayed discharges. The handbook describes how stakeholders were involved in building the whole systems model, how the model is used to plan services for older people.
Capturing the concealed: Interprofessional practice and older patients' participation in decision-making about discharge after acute hospitalization
- Authors:
- HUBY Guro, et al
- Journal article citation:
- Journal of Interprofessional Care, 21(1), January 2007, pp.55-67.
- Publisher:
- Taylor and Francis
The aim of this paper is to investigate ways in which the dynamics of interprofessional work shaped older patients' “participation” in decision-making about discharge from acute hospital care in a medical directorate of a District General Hospital in Scotland. Twenty-two purposively selected older patients and their key professional hospital carers in three different ward environments participated in the study. An ethnographic approach was adopted, involving semi-structured interviews with patients and staff combined with rigorous observation of the practical context for staff and patient interactions during the discharge planning process over a 5-month period. Patients' and staff's understanding of “decision-making” and their priorities for discharge were different, but patients' perspectives fragmented and became invisible. Care routines, which centred around assessments and the decisions that flowed from these tended to exclude both staff and patients from active decision-making. Research and practice on patient involvement in discharge decision-making needs to focus on the organizational context, which shapes patients', unpaid carers' and staff's interactions and the dynamics by which some views are privileged and others excluded. Procedurally driven care routines and their impact on patients', carers' and staff's opportunity to actively engage in decision-making should be re-considered from an empowerment perspective.
Hospital discharge of frail elderly people: social and ethical considerations in the discharge decision-making process
- Authors:
- CHADWICK R., RUSSELL J.
- Journal article citation:
- Ageing and Society, 9(3), 1989, pp.277-295.
- Publisher:
- Cambridge University Press
Focuses on issues of risk and autonomy and the use of artificial need categories to manage resources.
Making decisions together
- Authors:
- UNIVERSITY OF BRIGHTON, AGE UK BRIGHTON AND HOVE
- Publishers:
- University of Brighton, Age UK Brighton & Hove
- Publication year:
- 2013
- Pagination:
- 13 minutes and 10 seconds
- Place of publication:
- Brighton
One of six films made as part of an ESRC funded participatory research project which explored what well-being means to older people and how it is generated. The research was carried out by a team of older people, university researchers and a voluntary sector manager. This film re-visits Patrick and Gillian who have not been coping as well as they would have liked following Gillian's discharge from hospital after recovering from a fall. Taking the advice of Paul, a voluntary sector worker, they have contacted Social Services to request a formal assessment. Chloe, a social worker meets them to carry out this assessment. This scenario explores the way in which well-being involves making decisions about support and necessary adjustments that work for both partners. The film is a scripted scenario based on interviews. (Edited publisher abstract)
Hospital discharge planning: carrying out orders?
- Author:
- MOODY Harry R.
- Journal article citation:
- Journal of Gerontological Social Work, 43(1), 2004, pp.107-117.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Social workers working in hospital discharge planning face recurrent conflicts between patients' rights and the pressures of managed care. What should professionals do when confronted with orders that violate their conscience even where they do not violate the law? Exemptions for hardship or religious identity may or may not provide a basis for case-by-case decision-making. When confronted by ethical conflicts, discharge planners may be tempted to manipulate diagnostic categories in order to prolong a hospital stay. A better approach is to change policy at the institutional level so that professionals are not faced with a choice between sacrificing themselves or following ethical standards as patients prepare to leave the hospital. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Implementing reimbursement around discharge from hospital
- Author:
- GREAT BRITAIN. Department of Health. Health and Social Care Joint Unit
- Publisher:
- Great Britain. Department of Health. Health and Social Care Joint Unit
- Publication year:
- 2002
- Pagination:
- 15p.
- Place of publication:
- London
Older people should not have to wait o leave hospital when they are ready to do so. The government intends, subject to legislation, to introfduce a system of reimbursement at the point when responsibility for a patient's care transfers from the NHS to social services, by April 2003.
Clinical decision making, risk and occupational therapy
- Authors:
- REICH S., et al
- Journal article citation:
- Health and Social Care in the Community, 6(1), January 1998, pp.47-54.
- Publisher:
- Wiley
Discusses how little is known about the processes involved in risk taking, and complex decision making of the type of encountered on acute medical wards in general hospitals. This article examines certain of these processes in the context of decisions to discharge elderly in-patients from hospital. Vignettes of hypothetical frail and disabled elderly in-patients were presented to student and qualified occupational therapists (OTs). Finds that undergraduate syllabi may need to be modified to incorporate more information about elderly people, the prevalence of different diseases, and direct experience of clinical decision making in the context of uncertain and risky situations.
Snap decision
- Author:
- GEORGE Mike
- Journal article citation:
- Community Care, 2.5.96, 1996, pp.32-33.
- Publisher:
- Reed Business Information
Hospital social workers often have to make rapid judgments with little knowledge of their client. The author reports on one worker's dilemma.
Who recommends long-term care matters
- Authors:
- KANE Robert L., BERSHADSKY Boris, BERSHADSKY Julie
- Journal article citation:
- Gerontologist, 46(4), August 2006, pp.474-482.
- Publisher:
- Oxford University Press
Making good consumer decisions requires having good information. This American study compared long-term-care recommendations among various types of health professionals. The authors gave randomly varied scenarios to a convenience national sample of 211 professionals from varying disciplines and work locations. For each scenario, the professional was asked to recommend the appropriate forms of long-term care. Although the professional respondents used the full spectrum of options offered to them, some professionals tended to favour the sector they worked in. Advanced practice nurses recommended day care and homemaking more and adult foster care less. Gerontologists used skilled nursing-facility placement more actively and rehabilitation, homemaking, and home health care less actively. Geriatricians and primary care physicians both favoured rehabilitation and skilled nursing-facility care and were both less enthusiastic about assisted living, homemaking, and informal care, but the geriatricians favoured day care more than did the primary care physicians. Registered nurses were highly supportive of assisted living, adult foster care, homemaking, and home health care, and they opposed skilled nursing-facility care. Social workers were less likely than other participants to endorse rehabilitation and adult foster care. Implications: Because consumer preference should be a major factor in making long-term-care decisions, many consumers need information about what options may best fit their situation. In the absence of empirical data on which types of long-term care work best for whom, consumers have to rely on expert judgment - but that judgment varies. Clients should be aware that an expert's background (as defined by discipline and work situation) may affect his or her recommendations. Each discipline appears to have its own set of experiences and beliefs that may influence recommendations.