Development and Implementation of Discharge Planning Service in Roozbeh Hospital

Abstract

Extended Abstract
1. Introduction
Psychiatric disorders have a high prevalence and impose a huge burden to societies all over the world. Despite the recent trend to develop community-based psychiatry services, hospital-based services are still an inevitable part of treatment process, especially for patients in acute phases. Nowadays, interventions focusing on the transition phase from inpatient to outpatient are gaining increasing attention. Each patient, after discharge from psychiatric inpatient ward, needs to be monitored for optimum adherence to outpatient pharmacological and non-pharmacological services. Discharge planning is a dynamic, collaborative and comprehensive process, which is aimed to promote the continuity of care after discharge and providing necessary services and support to the client and his/her caregivers. Recently, the efficacy of discharge planning has been shown in multiple studies on factors like re-admission, treatment adherence, length of stay, treatment costs, symptoms resolution and patients’ quality of life. In line with the above, we decided to develop and implement a discharge planning service in Roozbeh Hospital.
2. Method
We used an evidence-based service development model which contained five steps, including needs assessment, situation analysis, cost-effectiveness evaluation, prioritization and structural design. In the first step, the researchers must perform a comprehensive review of literature in the target field, to estimate the level of necessity of the service for their goal. The second step contains the assessment of the current level of the services provided in the field, based on some standard indices. Cost-Effectiveness study of the service comes after that, and in the fourth step the researcher must prioritize the possible suggested interventions based on indicators like the burden of disease, cost-effectiveness, feasibility and affordability.
At the end, developing the service structure, process and details would happen. This is worth to mention that some authors refer to the fourth and fifth steps together as the implementation phase. Implementation is also defined as a series of specific activities directed to make a program with specific features work. This process contains determining the criteria for staff selection and education, providing pre-requisites, forms and devices, determining the data registry system, providing educational material, and choosing the corresponded and coordinator individuals for each step. The review of literature has been performed using international scientific databases including Medline, Elsevier and Cochrane; and domestic databases including Noormags, Magiran, SID and Medlib. The search performed on keywords including discharge planning, patient management, case management, service development, service implementation, and service planning, in English and Persian, with no time or study design restriction.
3. Results
In brief, the majority of references found the discharge planning service efficient on improving factors like re-admission rate, treatment adherence, length of stay, costs of the treatment, symptom resolution, quality of life, suicide rate, and patients’ satisfaction. Needs assessment studies and situation analysis showed that Roozbeh Hospital had some deficits in both measured indicators. Based on the Health Information System of the hospital, we reviewed the adherence of the discharged patients to their outpatient visit, with more than half (56%) of the patients had no outpatient follow-up visit after discharge, and 37% had come just one time. Although 44% of our patients showed some degrees of follow-up visit adherence and it is about the average (21-76%) in other centers, this could be improved up to 47-95% like the centers developed discharge planning services. The other indicator was the length of stay, and its mean in Roozbeh Hospital (Based on the HIS data) was 28 days, and is above the national average (20.7 days), and far from other countries like Belgium (10.2 days), Italy (13.9 days) and Turkey (15 days).
In the next step, prioritization among possible interventions and designing the structure and details of this service in Roozbeh Hospital performed based on special needs of the center and feasibility of services, considering the principles mentioned in the literature such as continuity of care, availability of the service, comprehensiveness of domains, maximal patient and his/her family collaboration, and the patients’ individuality. Finally, a discharge planning program designed which includes following steps: patient data registration, needs assessment, coordinating services and checklists of the services. Although the discharge planning is a team-based service which includes the psychiatrist, psychologist, social worker, nurse, day center staff, and surely the patient and his/her caregivers, every patient would have a specific contact-person called treatment mediator, whom is one of the nurses of the admission ward.
The content of discharge planning service in the time of admission ideally includes four sessions. The session zero contains welcoming the patient by the nurse and reminding the ward rules. The first session would be on needs assessment and planning for them, and the second session would be on specific educations for the patient and the caregivers. In the last session at the time of discharge, the forms and checklists will be fulfilled.
4. Discussion
Discharge planning service development is proven to be efficient in many ways, and even seems to be an ethical necessity. We had some limitations in our study such as lacking a good relationship with extra-organizational structures and social support systems, and having no prior experience in this field in the country. Meanwhile, the results of integration of the service in other services of the hospital would be gathered and published later. Development and implementation of the discharge planning service has been performed for the first time in Iran, in Roozbeh Hospital and requires to be evaluated and revised continuously, and we hope that this program be prominent to other psychiatric inpatient centers and also higher order mental health organizations.
Acknowledgements
This paper was extracted from the PhD dissertation of the first author in Psychiatry and Psychology Research Center, Tehran University of Medical Sciences. We wish to thank Dr. Zahra Mirsepasi, Dr. Valentin Artounian, Dr. Fatemeh Ranjbar-Kermani and the staff of Roozbeh Hospital day center for their invaluable contribution in our study.
Conflict of Interest
The authors declare no conflicts of interest.

Full text

56
Spring 2018, Volume 24, Number 1
Iranian Journal of
PSYCHIATRY AND CLINICAL PSYCHOLOGY
Research Paper
Development and Implementaon of Discharge Planning Service in Roozbeh Hospital
1. Resident of Psychiatry, Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
2. Psychiatrist, Associate Professor, Department of Psychiatry, Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
3. Child and Adolescents Psychiatrist, Associate Professor, Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
4. Psychiatrist, Assistant Professor, Department of Psychiatry, Iranian Naonal Center for Addicon Studies, Tehran University of Medical Sciences, Tehran, Iran.
Hamidreza Toughi1, Vandad Shari2, Javad Alaghband-Rad3, *Behrang Shadloo4
Objecves Discharge Planning is a dynamic, collaborave and comprehensive process which is aimed to
promote the connuity of care aer discharge and providing necessary services and support to the client
and his/her caregivers. Recently, the ecacy of discharge planning has been shown in mulple studies
on factors like re-admission, treatment adherence, length of stay, treatment costs, symptoms resoluon
and paents’ quality of life.
Methods We used an evidence-based service development model which contained ve steps, including
needs assessment, situaon analysis, cost-eecveness evaluaon, priorizaon and structural design.
Results Needs assessment studies and situaon analysis showed that Roozbeh Hospital had some de-
cits in adherence to outpaent visit and length of stay indices. In the next step, priorizaon among pos-
sible intervenons and designing the structure and details of this service in Roozbeh Hospital performed
based on the principles menoned in the literature, needs of the center and feasibility of services, and
nally a comprehensive, collaborave and connuous program designed which includes some steps
which are paent data registraon, needs assessment, coordinang services and checklists of the aairs.
Conclusion Development and implementaon of the discharge planning service has been performed as
the rst one in Iran, in Roozbeh Hospital and requires to be evaluated and revised connuously, and we
hope that this program be prominent to other psychiatric inpaent centers and also higher order mental
health organizaons.
A B S T R A C T
Key words:
Mental disorders,
Paent discharge,
Health services
Received: 07 Nov. 2016
Accepted: 19 Jun. 2017
Extended Abract
1. Introduction
sychiatric disorders have a high prevalence
and impose a huge burden to societies all over
the world. Despite the recent trend to develop
community-based psychiatry services, hospi-
tal-based services are ill an inevitable part of
treatment process, especially for patients in acute phases.
Nowadays, interventions focusing on the transition phase
P
from inpatient to outpatient are gaining increasing atten-
tion. Each patient, after discharge from psychiatric inpa-
tient ward, needs to be monitored for optimum adherence
to outpatient pharmacological and non-pharmacological
services. Discharge planning is a dynamic, collaborative
and comprehensive process, which is aimed to promote the
continuity of care after discharge and providing necessary
services and support to the client and his/her caregivers. Re-
cently, the ecacy of discharge planning has been shown
in multiple udies on factors like re-admission, treatment
adherence, length of ay, treatment cos, symptoms reso-
* Corresponding Author:
Behrang Shadloo, MD
Address: Department of Psychiatry, Iranian Naonal Center for Addicon Studies, Tehran University of Medical Sciences, Tehran, Iran.
Tel: +98 (21) 55421155
E-mail: behrang.shadloo@gmail.com
Citation
Toughi H, Shari V, Alaghband-Rad J, Shadloo B. [Development and Implementation of Discharge Planning
Service in Roozbeh Hospital (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2018; 24(1):56-69. https://doi.
org/10.29252/NIRP.IJPCP.24.1.56
:
: https://doi.org/10.29252/NIRP.IJPCP.24.1.56
Use your device to scan
and read the arcle online

57
Spring 2018, Volume 24, Number 1
Iranian Journal of
PSYCHIATRY AND CLINICAL PSYCHOLOGY
lution and patients’ quality of life. In line with the above,
we decided to develop and implement a discharge planning
service in Roozbeh Hospital.
2. Method
We used an evidence-based service development model
which contained ve eps, including needs assessment, sit-
uation analysis, co-eectiveness evaluation, prioritization
and ructural design. In the r ep, the researchers mu
perform a comprehensive review of literature in the target
eld, to eimate the level of necessity of the service for
their goal. The second ep contains the assessment of the
current level of the services provided in the eld, based on
some andard indices. Co-Eectiveness udy of the ser-
vice comes after that, and in the fourth ep the researcher
mu prioritize the possible suggeed interventions based
on indicators like the burden of disease, co-eectiveness,
feasibility and aordability.
At the end, developing the service ructure, process
and details would happen. This is worth to mention that
some authors refer to the fourth and fth eps together
as the implementation phase. Implementation is also de-
ned as a series of specic activities directed to make a
program with specic features work. This process con-
tains determining the criteria for a selection and edu-
cation, providing pre-requisites, forms and devices, de-
termining the data regiry syem, providing educational
material, and choosing the corresponded and coordinator
individuals for each ep. The review of literature has
been performed using international scientic databases
including Medline, Elsevier and Cochrane; and domes-
tic databases including Noormags, Magiran, SID and
Medlib. The search performed on keywords including
discharge planning, patient management, case manage-
ment, service development, service implementation, and
service planning, in English and Persian, with no time or
udy design reriction.
3. Results
In brief, the majority of references found the discharge
planning service ecient on improving factors like re-ad-
mission rate, treatment adherence, length of ay, cos of
the treatment, symptom resolution, quality of life, suicide
rate, and patients’ satisfaction. Needs assessment udies
and situation analysis showed that Roozbeh Hospital had
some decits in both measured indicators. Based on the
Health Information Syem of the hospital, we reviewed the
adherence of the discharged patients to their outpatient visit,
with more than half (56%) of the patients had no outpatient
follow-up visit after discharge, and 37% had come ju one
time. Although 44% of our patients showed some degrees
of follow-up visit adherence and it is about the average (21-
76%) in other centers, this could be improved up to 47-95%
like the centers developed discharge planning services. The
other indicator was the length of ay, and its mean in Rooz-
beh Hospital (Based on the HIS data) was 28 days, and is
above the national average (20.7 days), and far from other
countries like Belgium (10.2 days), Italy (13.9 days) and
Turkey (15 days).
In the next ep, prioritization among possible interven-
tions and designing the ructure and details of this service
in Roozbeh Hospital performed based on special needs of
the center and feasibility of services, considering the prin-
ciples mentioned in the literature such as continuity of care,
availability of the service, comprehensiveness of domains,
maximal patient and his/her family collaboration, and the
patients’ individuality. Finally, a discharge planning pro-
gram designed which includes following eps: patient data
regiration, needs assessment, coordinating services and
checklis of the services. Although the discharge planning
is a team-based service which includes the psychiatri, psy-
chologi, social worker, nurse, day center a, and surely
the patient and his/her caregivers, every patient would have
a specic contact-person called treatment mediator, whom
is one of the nurses of the admission ward.
The content of discharge planning service in the time of
admission ideally includes four sessions. The session zero
contains welcoming the patient by the nurse and reminding
the ward rules. The r session would be on needs assess-
ment and planning for them, and the second session would
be on specic educations for the patient and the caregivers.
In the la session at the time of discharge, the forms and
checklis will be fullled.
4. Discussion
Discharge planning service development is proven to
be ecient in many ways, and even seems to be an ethi-
cal necessity. We had some limitations in our udy such
as lacking a good relationship with extra-organizational
ructures and social support syems, and having no
prior experience in this eld in the country. Meanwhile,
the results of integration of the service in other ser-
vices of the hospital would be gathered and published
later. Development and implementation of the discharge
planning service has been performed for the r time in
Iran, in Roozbeh Hospital and requires to be evaluated
and revised continuously, and we hope that this program
be prominent to other psychiatric inpatient centers and
also higher order mental health organizations.
Toughi H, et al. Development and Implementation of Discharge Planning Service in Roozbeh Hospital. IJPCP. 2018; 24(1):56-69.

58
Spring 2018, Volume 24, Number 1
Iranian Journal of
PSYCHIATRY AND CLINICAL PSYCHOLOGY
Ethical Considerations
Funding
This paper was extracted from the PhD dissertation of the
r author in Psychiatry and Psychology Research Center,
Tehran University of Medical Sciences.
Conict of Intere
The authors declare no conict of intere.
Acknowledgements
We wish to thank Dr. Zahra Mirsepasi, Dr. Valentin Artou-
nian, Dr. Fatemeh Ranjbar-Kermani and the a of Rooz-
beh Hospital day center for their invaluable contribution in
our udy.
Toughi H, et al. Development and Implementation of Discharge Planning Service in Roozbeh Hospital. IJPCP. 2018; 24(1):56-69.

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






















  


1. Burden of Diseases
      






      
2. Connuity of care
3. Community Mental Health Centers (CMHC)
4. Day Centers
5. Discharge Planning Services







   
        
      

      




       

  







       
          

 



 



     


         

  
6. Caregivers
7. Deinstuonalizaon
8. Evidence Based










 










  
       





     

       

9. Cost-Eecveness
10. Implementaon
11. Medline
12. Elsevier
13. Cochrane
14. hp://www.noormags.ir/
15. hp://www.magiran.com/
16. hp://sid.ir/
17. hp://www.medlib.ir
18. Case management


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 



  


        









   



   
   


   


     










19. A small reducon
20. High level of evidence
21. Literature review
22. Consensus statement
23. Descripve studies








 









































       







         




       
 
 

 


      

      

24. Adherence
25. Hospital Informaon System (HIS)









       






   









26. World Health Organizaon Assessment Instrument for Men-
tal Health Systems (WHO-AIMS)





 
       


●



●

●
،


Cuel, 2002 [31]


Forchuk, 2005
[32]





Karniel-Lauer,
2000 [33]





Naji, 1999 [34]





Naoki, 2002 [35]





Nelson, 2014 [24]


Olfson, 1998 [36]




Orlosky, 2007
[37]


Reynolds, 2004
[38]





Sharma, 1995
[39]


Shaw, 2000 [21]





Swanson, 1999
[40]



1. Randomized Controlled Trial (RCT); 2. Controlled Clinical Trial (CCT); 3. Randomized Trial (RT)
 






       ●

       ●

●

   ●

●

●
 



27. Case management



●

       ●
        

●


       ●

●

●



SMI


HV
DCTF
















 












 
●










 
       

  
  










       
        
   
   



      

 



28. Case manager
29. Incident report

    













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
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






30. Severe mental illness
31. Day Center (DC)
32. Telephone Follow up (TF)
33. Home Visit (HV)
34. SMS reminder
















    

      








       







35. Global Assessment of Funconing (GAF)
36. Role play
37. Focused group sessions



 


      

       
      







 










        

        




  






       
      

     

 





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Spring 2018, Volume 24, Number 1
Iranian Journal of
PSYCHIATRY AND CLINICAL PSYCHOLOGY
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