5.6.1 A system under pressure: The discharge process in an acute hospital (444)

Michael Connolly, Macmillan Nurse Consultant, Palliative Care, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom Co authors: Jane Grimshaw, Mary Dodd, Julie Cawthorne, Tarnya Hulme, Sarah Everrit, Stephanie Tierney & Christi Deaton. michael.connolly@smtr.nhs.uk

Abstract:

Background:

Discharge is a multi-disciplinary procedure, in which nurses play a pivotal role. Unfortunately, this process does not always run smoothly (Glasby 2003).

Aims:

To understand the perspective of health professionals with regard to preparing patients for discharge from an acute hospital in England.

Methods:

Posters were displayed within a hospital asking for volunteers to take part in a focus group. Maximum variation, in terms of job titles, was striven for within the sample. Focus groups were held in December 2006 at participants’ place of work. Six senior members of staff divided into pairs to run them. All groups were taped and transcribed verbatim and analysed using a framework approach (Ritchie et al 2003).

Results:

Due to time and resource constraints, three focus groups were conducted, which involved 11 nurses, 15 allied health professionals, 5 social workers and 1 doctor. Analysis identified the following themes and sub themes: 1. Conflicting pressures on staff. Keeping patients in hospital versus getting them out Striving for flexibility within a system A paucity of intermediary provision 2. Consequences of conflicting pressures Professionals losing their sense of professionalism Patients being ‘systematised’

Discussion:

Pressures described during focus groups stemmed from five main sources:

external targets placed upon the system
internal hospital inflexibility and poor communication
dominance of the medical model of care
a desire to address the complex needs of individuals
a lack of community services.

Conclusions:

Data implied that practitioners are under pressure to process discharge planning quickly, within systems where staff are poorly coordinated and within a model of care that assigns little priority to social and psychological factors. It is clear from focus group data that staff can feel like victims of this pressure. Staff described the dehumanising effects of having to ignore patient concerns, wishes and choices.

Biography:

Michael Connolly is a Macmillan nurse consultant in supportive and palliative care at The University Hospital of South Manchester NHS Foundation Trust and an honorary lecturer at Manchester University School of Nursing, Midwifery and Social Work. He has led a team of nurse and physiotherapy consultants in his hospital in a collaborative research project with researchers from Manchester University.