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Table 3 Functional performance and outcome variability in hospital discharge of elderly patients

From: Hospital discharge of the elderly-an observational case study of functions, variability and performance-shaping factors

Functions Variability in discharge practices Variability in outcome
  Time and duration Precision  
Review of hospital inpatients—classifying patients that are medically fit for discharge. Time of day when the decision was determined. Criteria upon which the decision was established and degree of knowledge sharing with the care team. Time of day the patient was determined medically fit (i.e., duration of the discharge process) Patient’s degree of readiness Receiving health-care provider’s degree of satisfaction with the decision about medical fitness.
Notifying the municipality that the patient is medically fit. Time of day when the municipality was notified. Degree of compliance with cooperation agreements. Duration of the discharge process (i.e., delay in the discharge process in the case of non-compliance).
Informing the patient that they are ready for discharge. Time of day the patient was informed and time allotted to each patient. Approaches concerning content or type of information provided, the language used, and how the patient was approached. Patient involvement in the discharge planning process and degree of satisfaction.
Assigning an appropriate post-discharge site of care and notifying the hospital. Time of day the hospital was notified Criteria for prioritizing patients for post-discharge care. Duration (i.e., number of additional days spent after being determined medically fit). Level of post-discharge care offered. Degree of satisfaction concerning post-discharge arrangements.
Notifying and informing the patient’s next of kin (if any). Time of day relatives were informed and time spent. Degree of information provided and by whom (level of competence, doctor or nurse). Next of kin’s degree of satisfaction and perceived involvement in the discharge planning process.
Preparing a nursing discharge record. Time of day the record was prepared and time available (time spent). Prevalence and quality of the contents. Quality of the information transfer Receiving health-care provider’s degree of satisfaction.
Preparing a medical discharge letter. Time of day the letter was prepared and time available (time spent). Quality of the contents, structure, and readability. Quality of the information transfer Receiving health-care provider’s degree of satisfaction.
Providing oral information about the transfer to post-discharge care providers. Time of day and time spent. Degree and quality of the information provided and by whom (level of competence). Receiving health-care provider’s degree of satisfaction.
Ordering transportation. Time/hour arranged for transfer. The choice of arrangements and transportation (taxi, ambulance, next of kin) and the dialogue between the doctor and nurse. The responsible doctor’s involvement in the decision concerning the time for transfer—affected degree of time pressure to prepare the medical discharge letter.
Transferring the patient to the post-discharge site of care and ensuring the transfer of written information. Time of day the patient was transferred. Degree of compliance with arrangements. Unpredictable if carried out by the ambulance service (owing to simultaneous responsibilities). Time of day the patient arrived in primary care and the receiving health-care provider’s degree of satisfaction with the time of arrival.