Discharge planning practices with hospital psychiatric patients
Creators: name: Walker, Duane D.
Publisher: name: University of Utah
Year: 2012
Subjects: Universtiy of Utah Medical Center
Retrospective Study

description: This study was done to determine what written documentation exists in the psychiatric patient's record after discharge from the University of Utah Medical Center that indicates and supports the premise that there is discharge planning of appropriate quality to withstand the scrutiny of objective review by external monitoring and regulating agencies.  The purpose of this study was to determine the type of planning that took place and was documented prior to the patient being discharged, thus providing a data base for the development of criteria for a quality assurance program for psychiatric patients.  Determination of the outcomes of such a program is dependent on such a data base.  The survey of psychiatric patients' charts was designed to determine what specific activities occurred over a three month period, and were documented, relative to planning for a patient's discharge from the hospital.  What was recoded in the patient's record that reflected and documented the University of Utah Hospital's discharge planning program?  It was considered that this information would provide baseline data upon which more discriminatory studies could be designed in the future.  The research design was a retrospective study in the form of survey of information in the patient's chart to identify the clinical material available for use as guidelines for discharge planning programs.  The survey included admission data and discharge data.  Standard hospital record forms were used to determine what information had been obtained from patients.  Discharge notes of physicians, nurses, and other members of the professional team were reviewed and the information was categorized.  The admission data were complete for the 79 patients with regard to demographic information of sex, age, residence, religion, and marital status, and the time of day and type of admission.  A total of 29, or 36%, of 79 charts did not have educational level information and 17, or 22%, of the charts did not have present employment data.  The discharge data showed 39, of 49%, of the 79 patients had one or more leaves of absence before their discharge from the hospital.  Information available on follow-up referral of he 60 Salt Lake City and County patients showed 17, or 29%. Had an appointment to see a private psychiatrist; 31, or 52%, were referred to a community mental health center; 5, or 8%, to alcohol rehabilitation programs; 5, or 8%, to the Utah State Hospital; and 2, or 3%, were discharged against medical advice.  Forty-seven patients, or 60%, were discharged on major or minor tranquilizing medications.  Only 10, or 12%, of the 79 charts reviewed had documentation with regard to patient teaching.  Examination of the discharge diagnosis of the patients revealed that 32% were diagnosed as having schizophrenia, 21% depression, 12% personality disorders, 6% drug and alcohol abuse, and 26% had not discharge diagnosis.  The data are significant in that characteristics of schizophrenic patients, especially in regard to their difficulty in establishing and maintaining relationships, need to be considered for a follow-up treatment program.  Implications for developing discharge planning programs for psyiatric patients were discussed and recommendations were made for future research.