EVERYONE carries with them a story of a hospital discharge gone badly, whether it be their own, or the story of a neighbour or parent.
Research echoes these stories. For decades, we have been discharging people “sicker and quicker” from our hospitals, sometimes triggering dire consequences. Many hospital discharges result in another health crisis that requires medical attention or hospital readmission, such as a fall or a medication error.
The situation is even more dangerous for adults who are older, poorer, sicker, racialized and/or living rurally, as they face additional problems such as culturally unsafe care and fewer services in their communities.
How did we get here?
More people are living longer, and with long-term chronic disease than at the time we established our system. Hospitals have tried to adapt to the increased demand by focusing on moving people through efficiently and quickly. This is called “patient flow.” The goal of patient flow is to ensure there will always be hospital services available to those who need them.
This is a helpful approach to a point. But it becomes a problem when we discharge people into the community who have unmet health needs, who then end up back in the hospital, defeating the original goal.
How to break this cycle? Research clearly tells us many adults end up back in hospital soon after discharge because they have not been involved enough in the planning, and do not receive enough social and health service support in the community right after hospital discharge.
Many older people have additional needs before leaving the hospital because of less robust social supports and more physical needs. However, needing to prioritize “flow” means that it can be difficult to do extensive planning in the hospital. This might not be an issue if our current community and home-care services were adequately flexible to seamlessly pick up people’s care in community, and robust enough to meet the large range of post-hospital care. But they are not.
The result is people feel abandoned after leaving the hospital. They may not understand how to care for themselves, or what to do if something goes wrong.
In Ontario, up to half of people leaving the hospital are not provided with, or do not understand, their hospital discharge instructions. And about two in five patients do not attend recommended followup visits after a hospital stay because of challenges like mobility limitations, low health literacy, financial concerns, and a lack of social supports upon discharge. Manitoba has not released a comparable study, but we can assume it would be similar.
This situation is not the fault of any individual health-care provider. They work in a very stretched system, where there is little time to spend with patients once their initial health crisis resolves. Providers have limited supports for coordinating care between the hospital and community services, despite all the paperwork required of them.
To make matters worse, this situation might be a major driver of burnout. Nurses are most satisfied when they can provide person-centred care, attending to the unique needs of each patient. Even before the pandemic, the rates for severe burnout in health-care professionals was 30-40 per cent.
It’s past time to plan how the act of care will be delivered and received, for better patient and provider experiences. Improving the experience and safety for patients coming home from hospital is grounded in simple ideas, such as empowering patients and providers, communicating clearly, and ensuring people have basic care needs met in the community.
Patient-centric care is the kind of care patients want and need, the kind of care providers want to provide, and the kind of care Shared Health promised us they would prioritize in their health system transformation report in 2019.
While simple ideas, they require commitment to make into reality. Are we willing to make the investments it will take to interrupt the hospital revolving door?
Cara L. Brown is an assistant professor in the department of occupational therapy, College of Rehabilitation Sciences at the University of Manitoba. She is leading a team of researchers (including Patty Thille) and people who have lived experience with care transitions as a patient or caregiver (including Simone Moorhouse, Gail Pelletier and Trish Rawsthorne) who are working on their own research on this topic from a Manitoba context.
