- Leaving a hospital or GP practice after a fall
- A regular visit from a community nurse
- Moving back home after respite care in a care home
There is an understandable focus on ensuring the discharge process makes a greater contribution to an older person’s quality of life.
In an interesting post on KevinMD, Suneel Dhand wrote about general discharges from hospitals and the current potential for patient confusion due to the use of medical jargon. To quote from the post “A small investment...in beautiful, colourful, easy-to-read discharge instructions... “ could realise “..enormous potential benefits”.
As you can imagine the potential for confusion is even greater with the older community – so what could be done.
Benefits of using outcomes in discharge instructions
Outcomes are simple goals that the person can work towards through a series of regular activities with the full support of a multi-disciplinary care team. I believe that this would be relevant in any of the discharge scenarios I listed at the start of the post.
Outcomes is also a process that enables the older person to participate in their care plan
- By stating their preferred outcomes and desired quality of life
- Enabling the older person’s strengths, aspirations and previous life history to be incorporated into planning the person’s ongoing care
Multi-disciplinary care & Outcomes - a good match
Outcomes are also applicable and equally important in a prevention scenario – for example reducing the probability of older person having a fall as much as in a rehabilitation scenario.
One excellent example of an Outcomes based process is Talking Points as developed by the Joint Improvement Team in partnership with NHS Scotland and now in use in a number of Scottish health authorities.
The use of outcome as part of an older person’s care and risk assessment is a feature we are building into our Assesspatient’s solution.