Parental readiness for hospital discharge and the relationship with growth and development of infant in China.

PURPOSE: This study aimed to evaluate the associations between parental readiness for discharge and neonatal growth. DESIGN AND METHODS: This cross-sectional study included 549 newborns whose parents filled out the Newborn-Parental Readiness for Discharge Scale (N-PRDS).Additionally, data on birth weight, length, and head circumference were collected.The total N-PRDS scores were divided into three levels in terms of readiness: low, intermediate, and high readiness. Parents and infants were followed up 42 days after the birth, and the weight, length, and head circumference of the newborns were measured at the hospital. RESULTS: A total of 306 data were obtained. The generalized linear mixed model (GLMM) showed that time and parental readiness had an interaction effect on the weight, length and head circumference of infants. The difference in weight between infants under the high and low readiness conditions at 42 days increased by 0.357 kg compared to the difference at birth. The difference in length between high readiness infants and low readiness infants at 42 days increased by 2.155 cm compared to the difference at birth. The difference between the infants' head circumference under the high and low readiness conditions at 42 days was 0.873 cm higher than that at birth. CONCLUSIONS: High readiness for discharge could promote an increase in infant weight, length,and head circumference at 42 days after birth. PRACTICE IMPLICATIONS: Nurses should assess parental readiness prior to the discharge of newborns by using the N-PRDS and provide discharge guidance and education to newborns' parents based on the outcomes of this scale.

Parenting self-efficacy and parenting stress mediates the effects of the association of perceived social support and readiness for discharge among parents of children with primary nephrotic syndrome.

PURPOSE: To investigate the level of readiness for discharge among parents of children with primary nephrotic syndrome and to explore the mediating role of parenting self-efficacy and parenting stress between perceived social support and readiness for discharge. DESIGN AND METHODS: A cross-sectional study was conducted in five large tertiary general hospitals in Hunan, China. Data related to demographics, perceived social support, parenting self-efficacy, parenting stress, and readiness for discharge were collected from 350 parents of children diagnosed with primary nephrotic syndrome. Path analysis was used to determine the mediating roles of parenting self-efficacy and parenting stress in the relationship between perceived social support and readiness for discharge. RESULTS: Parents of children with nephrotic syndrome in China experienced low perceived social support, low readiness for discharge, and high parenting stress. Factors influencing readiness for discharge include the child's age, duration of illness, first episode or relapse, parental literacy and marital status. Parenting self-efficacy and parenting stress mediated the effects of the association of perceived social support and readiness for discharge. CONCLUSION: Perceived social support influences the readiness of parents of children with nephrotic syndrome. Parenting self-efficacy and parenting stress have a chain mediating effect of the association of perceived social support and readiness for discharge. PRACTICE IMPLICATIONS: This study emphasizes the mediating role of the psychological state of the child's parents. Nurses should take steps to increase perceived social support and parenting self-efficacy of the child's parents and to reduce parenting stress in order to improve readiness for discharge.

Rol de los cuidados perioperatorios guiados por protocolo para mejorar la recuperación tras la cirugía de cáncer de cabeza y cuello: experiencia institucional / Role of protocol-guided perioperative care to enhance recovery after head and neck neoplasm surgery: An institutional experience

Antecedentes: Enhanced recovery after surgery (ERAS) mejora la recuperación tras la cirugía. El objetivo de este estudio fue determinar si ERAS causa una reducción de la estancia hospitalaria y mejora la recuperación funcional global tras la cirugía de cáncer de cabeza y cuello. Métodos Realizamos un estudio prospectivo de control de casos histórico tras la aplicación de ERAS. La base de datos del hospital seleccionó 50 pacientes elegibles confirmados para el grupo control no ERAS, incluyéndose prospectivamente 54 pacientes en el grupo ERAS. El resultado primario fue el tiempo transcurrido hasta la disposición al alta (TRD), siendo los resultados secundarios la duración de la estancia hospitalaria (DEH), la tasa de reingreso de hasta 30 días y la puntuación QoR-15 (Quality of recovery). Los datos fueron comparados mediante pruebas paramétricas y no paramétricas adecuadas. Resultados Los datos demográficos basales de los pacientes fueron comparables entre ambos grupos. Los pacientes del grupo ERAS reflejaron un TRD significativamente más breve, en comparación con el grupo no ERAS: 8 (6-10) frente a 11 (8-16); p=0,002. La DEH fue también significativamente más corta en el grupo ERAS en comparación con el grupo no ERAS (8 [7-11] frente a 12 [9-17]; valor p=0,002). El reingreso en el plazo de 30 días no fue diferente, con una cifra de 6 pacientes en cada grupo. La puntuación QoR-15 fue estadísticamente mejor en el grupo ERAS (94,88±12,50) en comparación con el grupo no ERAS (85,44±12,68; p <0,001). Conclusión La implementación del programa ERAS redujo el TRD y la DEH, mejorando la puntuación QoR-15 sobre el resultado de la recuperación reportado por el paciente en las cirugías de cáncer de cabeza y cuello. (AU)

Background: Enhanced recovery after surgery (ERAS) improve recovery after surgery. This study aimed to determine whether ERAS leads to a decrease in stay in the hospital and improves global and functional recovery after head and neck neoplasms surgery. Methods We performed a prospective case and historical control study after the ERAS application. The hospital database selected 50 confirmed eligible patients in control non-ERAS group. Prospectively 54 patients were included in the ERAS group. The primary outcome was time to readiness for discharge (TRD); secondary outcomes were the length of stay (LOS), readmission rate of up to 30 days and Quality of recovery score QoR-15. Data were compared with appropriate parametric and nonparametric tests. Results Baseline demographic data of patients were comparable between the two groups. Patients in ERAS group had significantly shorter TRD compared to the non-ERAS group 8 (6-10) versus 11 (8-16); P=.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group (8 [7-11] versus 12 [9-17]; P=.002). Readmission at 30-days was no different, with six patients in each group. QoR-15 score was statistically better in ERAS group (94.88±12.50) compared to non-ERAS group (85.44±12.68; P<.001). Conclusion Implementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery. (AU)

Role of protocol-guided perioperative care to enhance recovery after head and neck neoplasm surgery: An institutional experience.

BACKGROUND: Enhanced recovery after surgery (ERAS) improve recovery after surgery. This study aimed to determine whether ERAS leads to a decrease in stay in the hospital and improves global and functional recovery after head and neck neoplasms surgery. METHODS: We performed a prospective case and historical control study after the ERAS application. The hospital database selected 50 confirmed eligible patients in control non-ERAS group. Prospectively 54 patients were included in the ERAS group. The primary outcome was time to readiness for discharge (TRD); secondary outcomes were the length of stay (LOS), readmission rate of up to 30 days and Quality of recovery score QoR-15. Data were compared with appropriate parametric and nonparametric tests. RESULTS: Baseline demographic data of patients were comparable between the two groups. Patients in ERAS group had significantly shorter TRD compared to the non-ERAS group 8 (6-10) vs 11 (8-16); p-value = 0.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group [8 (7-11) vs 12 (9-17); p-value = 0.002]. Readmission at 30-days was no different, with six patients in each group. QoR-15 score was statistically better in ERAS group (94.88 ±â€¯12.50) compared to non-ERAS group (85.44 ±â€¯12.68) [p value < 0.001]. CONCLUSION: Implementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery.

Comparison of unilateral spinal anaesthesia with ultrasound-guided combined sciatic and femoral nerve block in elective arthroscopic knee surgeries.

Background: Arthroscopic knee surgeries are commonly performed orthopaedic procedures, which can be done under unilateral spinal anaesthesia (USA) or ultrasound-guided combined sciatic and femoral nerve block (USFB). However, not many studies have compared both these techniques. Hence this study was undertaken to compare USA and USFB in arthroscopic knee surgeries in terms of time to readiness for discharge (TRD). Methods: Eighty patients were randomised into the USA (n = 40) and USFB groups (n = 40). They were administered either USA or USFB on the affected side. The TRD values were compared. Patients were considered fit for discharge after voiding urine, ambulation and obtaining a visual analogue scale (VAS) score of <3. The maximum time required for any of the three parameters was taken as the TRD for that particular patient. Results: The mean TRD was 595.41 ± 195.69 min in the USA group and 351.86 ± 129.51 min in the USFB group (p < 0.001). The median VAS scores for postoperative pain assessment were lower in the USFB group at 2, 4, 12 and 24 h (p < 0.05). The number of patients requiring rescue analgesia was lower in the USFB group at 6 and 12 h after surgery (p < 0.05). Conclusion: Patients undergoing arthroscopic knee surgeries under USFB have an advantage when it comes to TRD as these patients have comparatively better postoperative analgesia, less requirement of rescue analgesia, early voiding of urine and early ambulation.

Acceptability and Initial Adoption of the Heart Observation App for Infants With Congenital Heart Disease: Qualitative Study.

BACKGROUND: Approximately 1% of all infants are born with a congenital heart disease (CHD). Internationally CHD remains a major cause of infant death, some of which occur unexpectedly after a gradual deterioration at home. Many parents find it difficult to recognize worsening of symptoms. OBJECTIVE: This study aims to report the acceptability and initial adoption of a mobile app, the Heart Observation app (HOBS), aiming to support parents' understanding and management of their child's condition and to increase quality in follow-up from health care professionals in complex health care services in Norway. METHODS: A total of 9 families were interviewed on discharge from the neonatal intensive care unit and after 1 month at home. The infant's primary nurse, community nurse, and cardiologist were also interviewed regarding their experiences about collaboration with the family. The interviews were analyzed inductively with thematic content analysis. RESULTS: The analysis generated 4 main themes related to acceptability and adoption: (1) Individualize Initial Support, (2) Developing Confidence and Coping, (3) Normalize When Appropriate, and (4) Implementation in a Complex Service Pathway. The receptivity of parents to learn and attend in the intervention differs according to their present situation. Health care professionals emphasized the importance of adapting the introduction and guidance to parents' receptivity to ensure comprehension, self-efficacy, and thereby acceptance before discharge (Individualize Initial Support). Parents perceived that HOBS served them well and nurtured confidence by teaching them what to be aware of. Health care professionals reported most parents as confident and informed. This potential effect increased the possibility of adoption (Developing Confidence and Coping). Parents expressed that HOBS was not an "everyday app" and wanted to normalize everyday life when appropriate. Health care professionals suggested differentiating use according to severity and reducing assessments after recovery to adapt the burden of assessments when appropriate (Normalize When Appropriate). Health care professionals' attitude to implement HOBS in their services was positive. They perceived HOBS as useful to systemize guidance, to enhance communication regarding an infant's condition, and to increase understanding of heart defects in health care professionals with sparse experience (Implementation in a Complex Service Pathway). CONCLUSIONS: This feasibility study shows that both parents and health care professionals found HOBS as a positive addition to the health care system and follow-up. HOBS was accepted and potentially useful, but health care professionals should guide parents initially to ensure comprehension and adapt timing to parents' receptivity. By doing so, parents may be confident to know what to look for regarding their child's health and cope at home. Differentiating between various diagnoses and severity is important to support normalization when appropriate. Further controlled studies are needed to assess adoption, usefulness, and benefits in the health care system.

Correlation between self-efficacy and discharge readiness in patients with enterostomy / 中华健康管理学杂志

Objective:To explore the correlation between self-efficacy and discharge readiness in patients with enterostomy.Methods:It was a cross-sectional study. Using the self-efficacy Scale and the Readiness for Discharge Scale as research tools, the patients who underwent enterostomy in the Department of General Surgery of Peking Union Medical College Hospital from December 2018 to December 2019 were conveniently selected for questionnaire survey. Statistical descriptive variables such as mean values, median values and frequency were used to investigate the current situation of self-efficacy and discharge readiness of patients with enterostomy. Pearson correlation analysis (or Spearman correlation analysis) was used to explore the correlation between self-efficacy and discharge readiness in these patients.Results:The total self-efficacy score of the 121 patients with enterostomy was (75.81±21.16) points, and the total discharge readiness score was (138.11±34.60) points. The total score of self-efficacy in the patients with enterostomy was positively correlated with the total score of readiness for hospital discharge ( r=0.379, P<0.01). No correlation was found between the self-condition dimension and the confidence and efficacy of sexual life ( r=0.125, P>0.05) and the confidence and efficacy of sexual life satisfaction ( r=0.062, P>0.05). The disease knowledge dimension was positively correlated with the following variables, self-efficacy score ( r=0.311, P<0.01), stoma care efficacy ( r=0.358, P<0.01), self-social efficacy ( r=0.227, P<0.05), diet choice efficacy ( r=0.221, P<0.05) and stoma self-care confidence efficacy ( r=0.249, P<0.01). The post-discharge coping ability dimension was positively correlated with the total score of self-efficacy ( r=0.428, P<0.01). Anticipatory social support dimension was positively correlated with self-efficacy ( r=0.218, P<0.05), self-social efficacy ( r=0.226, P<0.01), vitality confidence ( r=0.202, P<0.05) and stoma self-care confidence ( r=0.198, P<0.05). Conclusion:The self-efficacy level of patients with enterostomy can positively predict the level of readiness for discharge.

Family-centred care and breastfeeding self-efficacy determined how ready mothers were for their infants to be discharged from a neonatal intensive care unit.

AIM: We examined if a range of factors were associated with how ready mothers were for their infants to be discharged from a neonatal intensive care unit (NICU). METHODS: This was a secondary analysis of a study on the well-being of mothers whose infants were hospitalised in the level 3 NICU at the Jewish General Hospital in Canada. We studied 132 mother-infant dyads: 70 from an open ward NICU and 62 from the purpose-built NICU with pods or single-family rooms that replaced it in 2016. The mothers completed a questionnaire on NICU stress and their perceptions of family-centred care on enrolment and another on breastfeeding self-efficacy and readiness to go home a week before discharge. The infants' characteristics were retrieved from the medical files. RESULTS: The infants were born at a mean age of 29.8 ± 3.1 weeks. Greater family-centred care during early hospitalisation (p = 0.01) and greater breastfeeding self-efficacy in the period before discharge (p = 0.04) were significantly associated with higher readiness for discharge. The unit design was not significantly associated with readiness for discharge. CONCLUSION: The quality of early family-centred care and breastfeeding self-efficacy were significantly associated with how ready mothers were for their preterm infant to be discharged from the NICU.

The impact of readiness to discharge from hospital on adherence to treatment in patients after myocardial infarction.

BACKGROUND: The healthcare professionals involved in in-hospital treatment of myocardial infarction (MI) are also responsible to patients for their education before leaving the hospital. This education aims to modify patient behaviour in order to reduce relevant risk factors and improve self-control and adherence to medications. The aim of the study was to analyse the relationship between readiness for discharge from hospital and adherence to treatment at follow-up in MI patients. METHODS: An observational, single-center, MI cohort study with 6-month follow-up was conducted between May 2015 and July 2016. The Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD-MIS) and the Adherence in Chronic Diseases Scale (ACDS) were applied. RESULTS: Two hundred and thirteen patients aged 30-91 years (62.91 ± 11.26) were enrolled in the study. The RHD-MIS general score ranged from 29 to 69 points (51.16 ± 9.87). A high level of readiness was found in 66 patients (31%), intermediate in 92 (43.2%), and low in 55 (25.8%) of patients. Adherence level assessed with the ACDS 6-months after discharge from hospital ranged from 7 to 28 points (23.34 ± 4.06). An increase in objective assessment of patient knowledge according to RHD-MIS subscale resulted in significantly higher level of adherence at the follow-up visit (p = 0.0154); R Spearman = 0.16671, p = 0.015; p for trend = 0.005. During the 6-month follow-up 3 (1.41%) patients died and 17 (7.98%) were hospitalized for a subsequent acute coronary syndrome. CONCLUSIONS: This study provided preliminary evidence of a long-term association between the results of assessment of readiness for discharge from hospital and adherence to treatment in patients after MI.

Effects of family integrated care on positive feelings and readiness for hospital discharge among mothers of premature infants / 中华行为医学与脑科学杂志

Objective:To investigate the effects of family integrated care(FICare) on positive feelings and readiness for hospital discharge among mothers of premature.Methods:From January to October 2021, a total of 100 premature infants were admitted to the neonatal intensive care unit(NICU) of General Hospital of Ningxia Medical University, and their mothers were admitted to this program.They were divided into research group (52 cases) and control group (48 cases) randomly.The premature infants in the control group received NICU routine care during hospitalization, meanwhile the premature infants and the mothers in the research group were given FICare on the routine care during hospitalization.On the 2nd day of admission (before the intervention) and 1 day before discharge (after the intervention), the positive aspects of caregiver (PAC) and the readiness for hospital discharge scale (RHDS) were used to evaluate the positive feelings and readiness for discharge of premature infants' mothers in the two groups.The t-test of two independent samples was used for measurement data between the two groups, and the paired t-test was used for intra-group comparison by SPSS 22.0 statistical software.The comparison of enumeration data between the two groups was carried out by chi-square test. Results:There were no significant differences in the scores of PAC and discharge readiness (both P>0.05) between the two groups before intervention.After the intervention, the premature mothers' total score of PAC in the research group and control group were((32.00±2.79), (27.40±3.37)), the self-affirmation dimension were ((18.55±2.39), (16.10±1.77)), the life outlook dimension were( (13.45±1.93), (11.30±2.20)), and all the scores in the research group were higher than those of the control group (all P<0.05). The total scores of readiness for hospital discharge in the research group and control group were ((106.75±6.11), (100.40±10.41)), personal status dimension were ((26.92±2.37), (25.11±3.32)), adaptability dimension were ((43.50±2.70), (40.64±4.65)), and the anticipatory support dimension were ((36.33±2.16), (34.29±3.29)). The total scores and each dimensions of the mothers' readiness for hospital discharge in the research group were higher than those in the control group (all P<0.05). After the intervention, the positive feeling total score and all dimensions score of the two groups of premature mothers were higher than before intervention (all P<0.05). After intervention, the total score of readiness for hospital discharge and the scores of all dimensions of premature mothers in the research group were higher than before intervention (all P<0.05). And there were no significant difference in the total scores of readiness for hospital discharge and other dimensions in the control group comparison before and after intervention(all P>0.05), except adaptability dimensions ( P<0.05). Conclusion:The findings suggest that FICare can improve the positive feelings of mothers of premature infants and hospital discharge readiness especially.

Reducing Length of Stay and Hospital Readmission for Orthopedic Patients: A Quality Improvement Project.

BACKGROUND: Transitioning patients from the hospital to home after a total hip or knee arthroplasty is challenging. Severe pain, comorbidities and complex medication regimes have the potential to delay readiness for discharge, increase length of stay (LOS), and cause readmissions. OBJECTIVE: The goal of this practice improvement project was to improve patient readiness for discharge after total joint arthroplasty to reduce LOS, prevent emergency department (ED) visits, and prevent hospital readmissions. METHODS: This quality improvement project was guided by the Iowa Model and implemented a prepost program implementation evaluation design. Nurses incorporated the Registered Nurse Assessment of Readiness for Hospital Discharge Scale (RN-RHDS) to guide and evaluate discharge education efforts. RESULTS: The focused education cohort demonstrated significantly decreased LOS and decreased readmissions compared to the cohort receiving standard education efforts. ED visits were not significantly different amongst cohorts. CONCLUSION: This practice improvement project demonstrates successful translation of research into practice. IMPLICATIONS FOR NURSING: The use of focused education and the RN-RHDS tool is recommended for nursing to improve patient readiness for discharge and patient outcomes.

Discharge teaching, readiness for hospital discharge and post-discharge outcomes in cataract patients: A structural equation model analysis.

AIM: To explore the interaction mechanism of cataract patients' quality of discharge teaching, discharge readiness and post-discharge outcomes using structural equation model analysis. BACKGROUND: The quality of discharge teaching and discharge readiness are two indicators used to evaluate the quality of hospital discharge services. Little research has been done on the quality of discharge teaching, discharge readiness and post-discharge outcomes in cataract patients, especially in China. METHODS: Four questionnaires were administered to 192 patients, and the results were analysed using Spearman's correlation and structural equation model. RESULTS: The statistical analysis showed low-to-moderate correlations among the quality of discharge teaching, discharge readiness and post-discharge outcome variables; discharge readiness played an intermediary role in the interaction mechanism of the three variables. CONCLUSION: The cataract patients demonstrated satisfactory quality of discharge teaching, discharge readiness and post-discharge outcomes. Quality of discharge teaching affected post-discharge outcomes through the intermediary role of discharge readiness. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should recognize the importance of discharge services, pay more attention to improve the quality of discharge teaching and strengthen discharge readiness to prevent the risks of post-discharge complications and readmission.

Analysis of status and influencing factors of parents' discharge preparation for preterm infants in intensive care unit / 中国实用护理杂志

Objective:To understand the level of discharge preparation of parents of premature infants in intensive care unit, and investigate the status of discharge preparation of parents of premature infants and its influencing factors.Methods:Convenient sampling was used to recruit the 202 parents of preterm infants who stayed in the neonatal intensive care unit in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from May to December 2018. The characteristics questionnaire and the Chinese version of Readiness for Hospital Discharge Scale-Parent Form were used to collect data.Results:The total score of parents' readiness for discharge of premature infants ranged from 111 to 290 (222.28±34.81). Multiple linear stepwise regression analysis showed that birth gestational age, birth weight, parity, parents' gender, annual family income were the influencing factors of premature parents' discharge readiness( P<0.05). Conclusions:The parents of premature infants in NICU are not well prepared for discharge. Medical staff should pay more attention to premature infants with low birth age and weight, first-born parents and low-income parents, so as to improve the discharge guidance content, help them prepare for discharge in all aspects and improve their care ability after discharge.

Effect of nursing led discharge instructions on improvement of post discharge care management in heart failure patients at tertiary care hospital of Karachi, Pakistan.

OBJECTIVES: To assess the impact of nursing discharge instructions on post-discharge care management in heart failure patients. METHODS: The quasi- experimental non-randomized study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from January to December 2017, and comprised in-patients suffering from heart failure. They were divided into two equal groups. In the intervention group, discharge instructions and written material was thoroughly given by the nurses other than routine existing instructions for effective post-discharge care management. The control group received discharged instructions under existing routine. Data was analysed using SPSS 21. RESULTS: Of the 80 patients, there were 40(50%) in each group with no significant difference in terms of age, gender and education (p>0.05 each). Regarding awareness and control of the disease, adherence with medication and proper management of their illness, the intervention group had higher level of competency than the control group (p=0.001). CONCLUSIONS: Provision of nursing interventions to educate the patient of heart failure during hospitalisation, on discharge, follow-up day and continuous guidance on telephone significantly improved the post-discharge care management of the patients.

Reliability and validity of the Readiness for Hospital Discharge Scale in patients with spinal cord injury.

BACKGROUND: Measuring rehabilitation outcomes in patients with spinal cord injury (PWSCI) requires measurement tools that are valid and reliable and have been psychometrically tested in the population with spinal cord injury (SCI). The Readiness for Hospital Discharge Scale (RHDS) has been found to be reliable and valid in adult surgical patients, post-partum mothers, parents of hospitalised children and geriatrics. However, the psychometric properties have not yet been tested in the population with SCI, furthermore, in a South African context. OBJECTIVES: The purpose of this study was to psychometrically test the internal consistency and construct validity of the RHDS as a measure of discharge readiness in PWSCI prior to discharge from rehabilitation units in the Tshwane metropolitan area, South Africa. METHOD: A cross-sectional study that included 50 PWSCI who were in their last week of rehabilitation was conducted. The RHDS item and scale statistics were calculated by using descriptive statistics and the scale reliability was measured for internal consistency by using Cronbach's alpha coefficients. To determine construct validity, convergent and divergent validities were measured by using the RHDS items' correlation coefficient dimensions. All data were tested at the 0.05 level of significance by using Statistics and Data (STATA) statistical software, version 14. RESULTS: Cronbach's alpha of the RHDS was 0.904, indicating an excellent reliability coefficient. Convergent validity scores showed 81% correlation coefficients, although divergent validity scores showed 62% correlation coefficients. CONCLUSION: The RHDS is a valid and reliable measure of readiness for discharge in a South African sample of PWSCI and can be used in SCI rehabilitation. CLINICAL IMPLICATIONS: Over and above using the RHDS to determine if PWSCI are ready for discharge in the clinical setting, the RHDS may also assist health care practitioners to assess the patient's progress towards readiness and strategies for addressing shortcomings to meet short and long-term goals of the rehabilitation process.

ERAS, length of stay and private insurance: a retrospective study.

PURPOSE: Hospital discharge after colorectal resection within an Enhanced Recovery After Surgery (ERAS) program occurs earlier compared to standard-care postoperative pathways but often later than what objective criteria of "readiness for discharge" could allow. The aim of this study was to analyse reasons and risk factors of such discharge delay. METHODS: All elective patients admitted for colorectal resection at the regional Hospital of Lugano in 2014 and 2015 were included. The postoperative day on which patients fulfilled consensus agreed criteria (according to Fiore) for readiness for discharge (POD-F) and the effective day of discharge (POD-D) were determined. We analysed the reasons for discharge delay (POD-D>POD-F) and performed univariate and multivariate analysis to determine risk factors. RESULTS: One hundred thirty-eight patients were included in the study. Median POD-F was 5 (2-48) days, POD-D was 6 (3-50) days. In 94 patients, POD-D occurred later than POD-F with a median delay of 1 (1-11) days. Reasons for discharge delay were insufficient social support in 13 (14%), patient's preference in 39 (41%) and medical team preference in 41 (44%). Private insurance (OR 2.61, 95%CI 1.08-6.34, p = 0.034) and patient discharged on a day other than Monday (OR 2.94, 95%CI 1.16-7.14, p = 0.023) were independent predictors for discharge delay. CONCLUSION: Even when objective criteria for readiness for discharge have been fulfilled, patients and/or doctors often do not feel comfortable with hospital discharge at this time point. Length of stay, even within an ERAS program, is still influenced by several non-medical factors and is therefore not a precise surrogate marker of outcomes.

Discharge teaching, readiness for discharge, and post-discharge outcomes in cataract patients treated with day surgery: A cross-sectional study.

Purpose: To investigate the quality of discharge teaching, readiness for hospital discharge (RHD), and post-discharge outcomes (PDO) of cataract patients in a day ward and to explore the relationships among these three variables. Methods: This cross-sectional study used an opportunistic sample from the ophthalmic day ward in a general hospital in Sichuan province, China. Data were collected using four questionnaires. Results: The total average score on the Quality of Discharge Teaching Scale was 192.95, and the dimension with the lowest score was "guidance obtained practically." The total average score on the Readiness for Hospital Discharge Scale was 175.51, and the dimension with the lowest score was "knowledge of disease." The total average score on the Post-Discharge Outcome Questionnaire was 77.08, and the four dimensions with the lowest scores were "compliance behaviors," "avoiding excessive use of eye," "avoiding strenuous exercise," and "regular check-up." Pearson correlation coefficients indicated low to moderate correlations between discharge teaching quality and PDO (0.245, P < 0.01), RHD and PDO (0.271, P < 0.01), and discharge teaching quality and PDO (0.559, P < 0.01). Conclusion: The quality of discharge teaching among cataract patients who underwent day surgery was relatively high, and patient preparation for discharge and PDO were good. However, medical staff should focus more attention on patients' individualized needs for discharge teaching while emphasizing the importance of compliance behavior.

Effects of Implementing a Health Team Communication Redesign on Hospital Readmissions Within 30 Days.

BACKGROUND AND RATIONALE: Poor communication between health team members can interfere with timely, coordinated preparation for hospital discharge. Research on daily bedside interprofessional health team rounds and nursing bedside shift handoff reports provides evidence that these strategies can improve communication. AIMS: To improve health team communication and collaboration about hospital discharge; improve patient experience of discharge measured by patient-reported quality of discharge teaching, readiness for discharge, and postdischarge coping difficulty; and reduce readmissions and emergency department (ED) visits postdischarge. METHODS: A two-sample pre- and postintervention design provided baseline data for redesign of health team communication processes and comparison data for evaluation of the new process' impact. Health team members (n = 105 [pre], n = 95 [post]) from two surgical units of an academic medical center in the midwestern United States provided data on discharge-related communication and collaboration. Patients (n = 413 [pre], n = 191 [post]) provided data on their discharge experience (quality of discharge teaching, readiness for discharge, postdischarge coping difficulty) and outcomes (readmissions, ED visits). Chi-square and t tests were used for unadjusted pre- and postintervention comparisons. Logistic regression of readmissions with a matched pre- and postintervention sample included adjustments for patient characteristics and hospitalization factors. RESULTS: Readmissions decreased from 18% to 12% (p < .001); ED visits decreased from 4.4% to 1.5% (p < .001). Changes in health team communication and collaboration and patients' experience of discharge were minimal. DISCUSSION: The targeted outcomes of readmission and ED visits improved after the health team communication process redesign. The process indicators did not improve; potential explanations include unmeasured hospital and unit discharge, and other care process changes during the study timeframe. LINKING EVIDENCE TO PRACTICE: Evidence from daily interprofessional team bedside rounding and bedside shift report studies was translated into a redesign of health team communication for discharge. These strategies support readmission reduction efforts.

Factors affecting readiness for discharge and perceived social support after childbirth.

AIMS AND OBJECTIVES: To evaluate the factors affecting readiness for discharge and perceived social support after childbirth. BACKGROUND: Many women still die during and following pregnancy and childbirth. Both early and late discharges are conflicting issues in the world. Evaluation of the readiness for discharge in terms of patient safety, satisfaction, physical, emotional, psychological and social aspects is important. DESIGN: Descriptive and cross-sectional study. METHODS: The study was carried out with 610 women in the early postpartum period at two hospitals in Turkey between October 2014-March 2015 using Readiness for Hospital Discharge Scale-New Mother Form and Multidimensional Scale of perceived social support. RESULTS: The mean scores for Readiness for Hospital Discharge Scale-New Mother Form and Multidimensional Scale of perceived social support were found as 163.5 (SD: 34.1) and 64.2 (SD: 18.8), respectively. Women who were discharged from Merkezefendi Hospital, women who had one child or one pregnancy and women or baby who experienced complication during or after birth had lower scores on Readiness for Hospital Discharge Scale-New Mother Form. Women who received information about the postpartum period had significantly higher scores on the total Readiness for Hospital Discharge Scale-New Mother Form than women did not (165.5 ± 33.8 vs 151.1 ± 36.1). Personal status, knowledge and total score of the Readiness for Hospital Discharge Scale-New Mother Form were significantly higher in women who were ready for discharge. CONCLUSIONS: Findings provide vital information that can inform nursing clinical practice, especially related to readiness for discharge protocols and developing strategies for women, who had low sociodemographic backgrounds, did not have any information about postpartum period and were not ready for discharge. RELEVANCE TO CLINICAL PRACTICE: The mother and family face with postpartum difficulties on their own when early discharge takes place. Providing postpartum care services plays an important role for maternal-child health.

Impact of laparoscopy on adherence to an enhanced recovery pathway and readiness for discharge in elective colorectal surgery: Results from the PeriOperative Italian Society registry.

INTRODUCTION: Previous studies reported that laparoscopic surgery (LPS) improved postoperative outcomes in patients undergoing colorectal surgery within an enhanced recovery program (ERP). However, the effect of minimally invasive surgery on each ERP item has not been clarified, yet. The aim of this study is to assess the impact of LPS on adherence to ERP items and recovery as measured by time to readiness for discharge (TRD). METHODS: Prospectively collected data entered in an electronic Italian registry specifically designed for ERP were reviewed. Patients undergoing elective colorectal surgery were divided into three groups: successful laparoscopy, conversion to open surgery, primary open surgery. Adherence to 19 ERP elements and postoperative outcomes were compared among groups. Multivariate regression analysis was used to identify whether LPS had an independent role to improve ERP adherence and postoperative outcomes. RESULTS: 714 patients (successful LPS 531, converted 42, open 141) underwent elective colorectal surgery within an ERP. Epidural analgesia was used in the 75.1% of open group patients versus 49.9% of LPS group patients (p = 0.012). After surgery, oral feeding recovery, i.v. fluids suspension, removal of both urinary and epidural catheters occurred earlier in the LPS group both in the overall series and in uneventful patients only. Mean TRD and length of hospital stay were significantly shorter in the LPS group (p < 0.001 for both). Overall morbidity rate was 18.7% in the LPS group versus 32.6% in the open group (p = 0.001). At multivariate analysis, LPS was significantly associated to an increased adherence to postoperative ERP items, a shorter TRD, and a reduced overall morbidity, whereas rectal surgery and new stoma formation impaired postoperative recovery. CONCLUSIONS: The present study showed that a successful laparoscopic procedure had an independent role to increase the adherence to postoperative ERP and to improve short-term postoperative outcome.