Abstract
Hospital discharge readiness is an important yet often elusive matter for pediatric patients, families, and health care providers. Caregiver readiness for discharge should be assessed both at admission and before discharge to allow for timely education and training. The Pediatric Readiness for Hospital Discharge Scale is recommended for use by OTs in an acute rehabilitation setting because they harness the unique ability to address both physical and psychosocial aspects of the child and family encompassed by the measure.
Primary Author and Speaker: Lori B. Ragni
Additional Authors and Speakers: Camille Velasco, Teresa Fitzsimons, and Katie Shniderman
Hospital discharge readiness is an important, yet elusive matter for pediatric patients, families, and health care providers. The perception of low readiness amongst caregivers has conveyed risk for post-discharge transition difficulty (Biffl & Biffl, 2015; Weiss et al., 2008; Weiss et al., 2019). Despite preparation, the medical team's perception of caregiver readiness often conflicts with caregivers' opinions of their own readiness, which can complicate and delay discharge. The purpose of this quality improvement project was to implement early discussion of discharge planning and training for increased preparedness for discharge on the pediatric acute inpatient rehabilitation (IR) unit. This data was gathered as standard of care from a quality improvement perspective from April 2019 to March 2020. The sample included caregivers of admitted patients to the pediatric acute IR unit. Admitted patients present with congenital and traumatic conditions, and a length of stay between 2-3 weeks. The goal for all patients is to discharge home. As part of an interdisciplinary program, the occupational therapy team led the administration of the Pediatric Readiness of Hospital Discharge Scale (PedRHDS). The PedRHDS is a 29-item, Likert style scale which aims to identify the perception of caregivers related to their readiness for their child's discharge home (Weiss & Piacentine, 2006). Total item scores are averaged with an overall mean score reported. Higher scores indicate greater readiness for discharge. The PedRHDS was administered to all caregivers at the time of admission and within 1-2 days of discharge in an effort to ensure no concerns remained, and caregivers expressed comfort with discharge home. Scores were communicated to the interdisciplinary team after each administration via email and at weekly team conferences. Each item on the scale was associated with an identified discipline to ensure item responses indicating ‘low readiness’ were promptly addressed (i.e. medication, financial concerns). All PedRHDS forms were compiled and transcribed. Stata 15.1 and Mplus statistical software were used for analysis. Negatively keyed items were reversed and total scores for admission and discharge scores were calculated for each patient. A total of 109 observations are included in this sample which consists of both admission and discharge scores for 41 patients and 26 patients with only either score. For 41 patients with both scores, descriptive statistics compared mean total baseline and discharge scores; 179 and 203 respectively. Items related to physical readiness of the child to go home, and knowledge related to available services once discharged yielded the lowest scores at admission. At discharge, the mean score for all items was above the midpoint of the Likert scale indicating ‘high readiness’ however the areas with lowest scores included caregiver stress and handling the child's behaviors/emotions at home. As no published psychometric data is available for this specific pediatric population, a 5-factor confirmatory factor analysis was used to understand the model fit. The entire, 109 observation data set was used, and the factor structure for this data modeled the 5 factors previously observed in a recent psychometrics study (Weiss et al., 2019). Caregiver readiness for discharge should be assessed at both admission and prior to discharge to allow for timely education and training by the interdisciplinary team. As leaders of this unit initiative, the valuable role of OTs in all aspects of discharge planning is highlighted. The PedRHDS is recommended in acute rehabilitation setting by OTs as they harness the unique ability to address both physical and psychosocial aspects of the child and family encompassed in the scale.
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