Caregiver Inclusion in IDEAL Discharge Teaching: Implications for Transitions From Hospital to Home

Emily Wahlquist Topham; Alycia Bristol; Brenda Luther; Catherine E Elmore; Erin Johnson; Andrea S Wallace

doi:10.1097/NCM.0000000000000563

Caregiver Inclusion in IDEAL Discharge Teaching: Implications for Transitions From Hospital to Home

Prof Case Manag. 2022 Jul-Aug;27(4):181-193. doi: 10.1097/NCM.0000000000000563.

Authors

Emily Wahlquist Topham^{1

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6}, Alycia Bristol^{1

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6}, Brenda Luther^{1

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6}, Catherine E Elmore^{1

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6}, Erin Johnson^{1

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6}, Andrea S Wallace^{1

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6}

Affiliations

¹ Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses.
² Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge.
³ Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians.
⁴ Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah.
⁵ Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research.
⁶ Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care.

Abstract

Purpose: Despite recognition that unpaid (e.g., family, friends) caregivers (caregivers) play an important role in successful transitions home after hospitalization, limited information is available about whether and how caregiver experiences of discharge align with current strategies for providing high-quality discharge processes, and how these experiences at discharge impact successful transitions home. The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted postdischarge patient outcomes.

Methods: We conducted in-depth, case interviews with four English-speaking caregivers (61-75 years of age). Content analysis was framed by the nature of caregiver involvement proposed by the Agency for Healthcare Research and Quality's (AHRQ's) IDEAL (Include, Discuss, Educate, Assess, Listen) discharge planning strategy.

Results: Caregivers reported receiving clear discharge instructions, or basic education, and yet felt only passively included in discharge teaching. Once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to postdischarge knowledge gaps.

Conclusion: The experiences of these caregivers demonstrate how their limited, passive involvement in discharge education may result in suboptimal patient outcomes after hospitalization. Our findings suggest that structured programs aimed at increasing caregiver involvement in discharge, particularly related to assessment of caregiver problem solving, planning, and postdischarge support, are important in efforts seeking to improve care transitions and postdischarge outcomes.

Implications for case management: This study assesses caregivers' experience with discharge planning and problems they encounter post-discharge, providing case managers with important information regarding the effectiveness of discharge processes. This study of caregiver experiences suggests that the IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.

MeSH terms

Aftercare
Caregivers*
Hospital to Home Transition
Hospitalization
Humans
Patient Discharge*

Grants and funding

R01 HS026248/HS/AHRQ HHS/United States