DOI: 10.14288/1.0433820
title: Transitions from hospital to home: A mixed methods study to evaluate pediatric discharges in Uganda

description: &lt;br /&gt;&lt;strong&gt;Background:&lt;/strong&gt; The World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) guidelines recognize the importance of discharge planning to ensure continuation of care at home and appropriate follow-up. However, insufficient attention has been paid to post discharge planning in many hospitals contributing to poor implementation. To understand the reasons for suboptimal discharge, we evaluated the pediatric discharge process from hospital admission through the transition to care within the community in Ugandan hospitals. &lt;br /&gt; &lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This mixed methods prospective study enrolled 92 study participants in three phases: patient journey mapping for 32 admitted children under-5 years of age with suspected or proven infection, discharge process mapping with 24 pediatric healthcare workers, and focus group discussions (FDGs) with 36 primary caregivers and fathers of discharged children. Data were descriptively and thematically analyzed.&lt;br /&gt; &lt;br /&gt;&lt;strong&gt;Findings:&lt;/strong&gt; The typical discharge process is often not centered around the needs of the child and family. Discharge planning often does not begin until immediately prior to discharge and generally does not include caregiver input. Discharge education and counselling are generally limited, rarely involves the father, and does not focus significantly on post-discharge care or follow-up. Delays in the discharge process itself occur at multiple points, including while awaiting a physical discharge order and then following a discharge order, mainly with billing or transportation issues.&lt;br /&gt; &lt;br /&gt;&lt;strong&gt;Data Collection Methods:&lt;/strong&gt; &lt;strong&gt;Journey mapping&lt;/strong&gt; data were collected using the REDCap Mobile App and were then uploaded to a REDCap database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). Study nurses conducted direct observation during in-hospital care as well as caregiver interviews at admission and 72 hours post-discharge using a series of checklists and close-ended questions with some open-entry questions to identify process outcomes as well as barriers and facilitators to the patient’s journey. Healthcare provider working groups engaged in two brainstorming sessions per hospital to develop a &lt;strong&gt;process map&lt;/strong&gt; of each hospital’s current pediatric discharge process and to identify inefficiencies to care and potential solutions. Using paper, pens, and sticky notes, group members jointly mapped out the discharge pathways of their respective facilities and jointly identified all stages of the process. Data were captured using worksheets and audio recordings. A trained research assistant facilitated &lt;strong&gt;FGD&lt;/strong&gt; two weeks after direct observation concluded with patient caregivers. Participants were asked to respond to open-ended questions that focused on their experiences regarding their child’s admission, hospital stay, discharge and post-discharge. All FGDs were digitally recorded, transcribed verbatim and translated into English by external individuals fluent in the languages. Healthcare provider working groups engaged in two brainstorming sessions per hospital to develop a map of each hospital’s current pediatric discharge process and to identify inefficiencies to care and potential solutions. &lt;br /&gt; &lt;br /&gt;&lt;strong&gt;Ethics Declaration:&lt;/strong&gt; Ethical approvals were obtained from Makerere University (HDREC #850), Uganda National Council for Science and Technology (#HS929ES) and the University of British Columbia (UBC C&W REB # H20-02519).&lt;br /&gt; &lt;br /&gt;&lt;strong&gt;Study Protocol & Supplementary Materials:&lt;/strong&gt; &lt;br /&gt; &lt;a href = "https://doi.org/10.5683/SP3/IDLGNN"&gt;Smart Discharges Transition to Scale&lt;/a&gt;&lt;br /&gt;