Discharge management: focus on socio-economically and ethnically deprived patients at the

postnatal and geriatric ward

Research group Integrated Care in Metropolitan area (INCAM Brussels)

DEFINITION OF DM

• The whole of activities carried out by the care providers to assure a good transfer from the intramural to the extramural setting for the patient

• DM=process in the care trajectory with crucial elements:

(1)Evaluation patient needs (before ward admission)(2) Transmural communication(3) Multidisciplinary collaboration(patient education included)(4) Clear written discharge planning in a comprehensive language

MOST IMPORTANT RESULTS (1)

- In addition to information & education, the patient needs practical & emotional support.

- A clear distribution of the caregivers’ roles & tasks at the discharge provides a higher patient’s satisfaction.

- Communication & collaboration between the different caregivers (primary as well as secondary health care) who together give form to the discharge, are of decisive importance BUT no discipline claims the coordination of the discharge + no clear coordination role of managing the discharge

MOST IMPORTANT RESULTS (2)

- Little literature about DM in specific target groups- Differentiation for ethnical and socio-economical

groups is very scarce, AND less information- A lot of literature about ED at the maternity ward

A lot of gaps are remaining to be able to pursue an effective discharge policy

More attention should be given to discharge, specifically to the preparation and communication, in particular for specific patient groups.

Discharge planning case managerThe development of transmural and

interdisciplinary care paths and protocols More research needed in this fieldNurses and midwives must be “culture sensitive”

CONTACT

Florence.dhaenens@ehb.be