Improving the Discharge Planning Process in Inpatient Rehabilitation

Abstract

The discharge planning process is a process that identifies the type of care you will need once you discharge from a healthcare facility and prepares you for the transition of care. An efficient discharge planning process can help prevent patients from experiencing adverse events, and, thus, reduce hospital readmissions. However, current literature suggests that healthcare facilities may struggle with maintaining an efficient discharge planning process due to discharge planning barriers and post-discharge concerns. One way to address this problem is through discharge planning, or transitional care, interventions designed to enhance this specific process. The ultimate purpose of this capstone project was to develop discharge planning interventions for a local inpatient rehabilitation hospital that identified gaps in its discharge process but lacked the resources to develop new interventions. After conducting a needs assessment, completing a literature review, and collaborating with crucial stakeholders, the capstone site was provided with two discharge interventions, a discharge checklist, and patient and caregiver resource binders. Utilizing an occupational therapy lens, the Plan-Do-Study-Act model, and the Adult Learning Theory, these interventions were designed to support and meet the needs of the patients, their caregivers, and the rehabilitation staff at the capstone site. Based on evaluation survey results, the site’s therapy staff were satisfied with the interventions as they perceived them to be beneficial for all the rehabilitation therapists, the patients, and the caregivers. Due to the project’s overall impact on the site and the profession of occupational therapy, this capstone project was deemed a success.