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Journal of the Australasian Society for the Study of Brain Impairment
RESEARCH ARTICLE (Open Access)

Health professionals’ practices and perspectives of post-stroke coordinated discharge planning: a national survey

Lara Ingram A , Rachelle Pitt A B and Kirstine Shrubsole https://orcid.org/0000-0002-7805-2447 A C D E *
+ Author Affiliations
- Author Affiliations

A School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.

B Office of the Chief Allied Health Officer, Queensland Health, Qld, Australia.

C Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.

D Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Qld, Australia.

E Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Vic., Australia.

* Correspondence to: k.shrubsole@uq.edu.au

Handling Editor: Natasha Lannin

Brain Impairment 25, IB23092 https://doi.org/10.1071/IB23092
Submitted: 29 August 2023  Accepted: 8 February 2024  Published: 7 March 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Australasian Society for the Study of Brain Impairment. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

It is best practice for stroke services to coordinate discharge care plans with primary/community care providers to ensure continuity of care. This study aimed to describe health professionals’ practices in stroke discharge planning within Australia and the factors influencing whether discharge planning is coordinated between hospital and primary/community care providers.

Methods

A mixed-methods survey informed by the Theoretical Domains Framework was distributed nationally to stroke health professionals regarding post-stroke discharge planning practices and factors influencing coordinated discharge planning (CDP). Data were analysed using descriptive statistics and content analysis.

Results

Data from 42 participants working in hospital-based services were analysed. Participants reported that post-stroke CDP did not consistently occur across care providers. Three themes relating to perceived CDP needs were identified: (1) a need to improve coordination between care providers, (2) service-specific management of the discharge process, and (3) addressing the needs of the stroke survivor and family. The main perceived barriers were the socio-political context and health professionals’ beliefs about capabilities. The main perceived facilitators were health professionals’ social/professional role and identity, knowledge, and intentions. The organisation domain was perceived as both a barrier and facilitator to CDP.

Conclusion

Australian health professionals working in hospital-based services believe that CDP promotes optimal outcomes for stroke survivors, but experience implementation challenges. Efforts made by organisations to ensure workplace culture and resources support the CDP process through policies and procedures may improve practice. Tailored implementation strategies need to be designed and tested to address identified barriers.

Keywords: barriers, coordinated discharge planning, discharge planning, facilitators, health professional perspectives, implementation, stroke, survey.

References

Abdul Aziz AF, Mohd Nordin NA, Muhd Nur A, Sulong S, Aljunid SM (2020) The integrated care pathway for managing post stroke patients (iCaPPS©) in public primary care Healthcentres in Malaysia: impact on quality adjusted life years (QALYs) and cost effectiveness analysis. BMC Geriatrics 20(1), 70.
| Crossref | Google Scholar | PubMed |

Adeoye O, Nyström KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, Khalessi AA, Bushnell C, Barsan WG, Panagos P, Alberts MJ, Tiner AC, Schwamm LH, Jauch EC (2019) Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement From the American Stroke Association. Stroke (1970) 50(7), e187-e210.
| Crossref | Google Scholar |

Allen D, Lyne P, Griffiths L (2002) Studying complex caring interfaces: key issues arising from a study of multi-agency rehabilitative care for people who have suffered a stroke. Journal of Clinical Nursing 11(3), 297-305.
| Crossref | Google Scholar | PubMed |

Almborg AH, Ulander K, Thulin A, Berg S (2009a) Discharge planning of stroke patients: the relatives’ perceptions of participation. Journal of Clinical Nursing 18(6), 857-865.
| Crossref | Google Scholar |

Almborg AH, Ulander K, Thulin A, Berg S (2009b) Patients’ perceptions of their participation in discharge planning after acute stroke. Journal of Clinical Nursing 18(2), 199-209.
| Crossref | Google Scholar |

Andrew NE, Busingye D, Lannin NA, Kilkenny MF, Cadilhac DA (2018) The Quality of Discharge Care Planning in Acute Stroke Care: Influencing Factors and Association with Postdischarge Outcomes. Journal of stroke and cerebrovascular Diseases 27(3), 583-590.
| Crossref | Google Scholar | PubMed |

Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N, Wensing M, Fiander M, Eccles MP, Godycki-Cwirko M, van Lieshout J, Jäger C (2015) Tailored interventions to address determinants of practice. Cochrane Database of Systematic Reviews CD005470.
| Crossref | Google Scholar | PubMed |

Cadilhac DA, Dalli LL, Morrison J, Lester M, Paice K, Moss K, Carter H, Campbell B, Cloud G, Kilkenny MF, Faux S, Dewey H, Hill K, Donnan G, Grimley R, Middleton S, Lannin NA, on behalf of the AuSCR Consortium (2022) The Australian Stroke Clinical Registry Annual Report 2021. The Florey Institute of Neuroscience and Mental Health; December 2022, Report No. 14, 66 pages. https://doi.org/10.26188/21753812

Cadilhac DA, Andrew NE, Stroil Salama E, Hill K, Middleton S, Horton E, Meade I, Kuhle S, Nelson MR, Grimley R, on behalf of the Australian Stroke Clinical Registry Consortium (2017) Improving discharge care: the potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study. BMJ Open 7(8), e016010.
| Crossref | Google Scholar | PubMed |

Cadilhac DA, Kilkenny MF, Longworth M, Pollack MRP, Levi CR (2011) Metropolitan-rural divide for stroke outcomes: do stroke units make a difference? Internal Medicine Journal 41(4), 321-326.
| Crossref | Google Scholar | PubMed |

Cameron JI, O’Connell C, Foley N, Salter K, Booth R, Boyle R, Cheung D, Cooper N, Corriveau H, Dowlatshahi D, Dulude A, Flaherty P, Glasser E, Gubitz G, Hebert D, Holzmann J, Hurteau P, Lamy E, LeClaire S, et al. (2016) Canadian Stroke Best Practice Recommendations: Managing Transitions of Care Following Stroke, Guidelines Update 2016. International Journal of Stroke 11(7), 807-822.
| Crossref | Google Scholar | PubMed |

Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science 7(1), 37.
| Crossref | Google Scholar | PubMed |

Carlsson E, Ehnfors M, Eldh A, Ehrenberg A (2012) Accuracy and continuity in discharge information for patients with eating difficulties after stroke. Journal of Clinical Nursing 21, 21-31.
| Crossref | Google Scholar | PubMed |

Chang HF, Power E, O’Halloran R, Foster A (2018) Stroke communication partner training: a national survey of 122 clinicians on current practice patterns and perceived implementation barriers and facilitators. International Journal of Language & Communication Disorders 53(6), 1094-1109.
| Crossref | Google Scholar | PubMed |

Chen L, Xiao LD, Chamberlain D (2020) An integrative review: Challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. Journal of Advanced Nursing 76(9), 2253-2265 https://doi.org/10.1111/jan.14446.
| Google Scholar | PubMed |

Creswell JW, Plano Clark VL (2011) ‘Designing and conducting mixed methods research’, 2nd edn. (SAGE Publications: Thousand Oaks)

Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N (2005) Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. Journal of Clinical epidemiology 58(2), 107-112.
| Crossref | Google Scholar | PubMed |

Ellis-Hill C, Robison J, Wiles R, McPherson K, Hyndman D, Ashburn A (2009) Going home to get on with life: patients and carers experiences of being discharged from hospital following a stroke. Disability and Rehabilitation 31(2), 61-72.
| Crossref | Google Scholar | PubMed |

French SD, Greeb SE, O'Connor DA, et al. (2012) Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implementation Science 7, 38 https://doi.org/10.1186/1748-5908-7-38.
| Google Scholar |

Fulton EA, Brown KE, Kwah KL, Wild S (2016) StopApp: Using the Behaviour Change Wheel to Develop an App to Increase Uptake and Attendance at NHS Stop Smoking Services. Healthcare (Basel) 4(2), 31.
| Crossref | Google Scholar | PubMed |

Gonçalves-Bradley DC, Lannin NA, Clemson L, Cameron ID, Shepperd S (2022) Discharge planning from hospital. Cochrane Database of Systematic Reviews 2(2), Cd000313.
| Crossref | Google Scholar | PubMed |

Halladay M, Bero L (2000) Implementing evidence-based practice in health care. Public Money and Management 20(4), 43-50.
| Crossref | Google Scholar |

Hedberg B, Johanson M, Cederborg A-C (2008) Communicating stroke survivors’ health and further needs for support in care-planning meetings. Journal of Clinical Nursing 17(11), 1481-1491.
| Crossref | Google Scholar | PubMed |

Hesselink G, Zegers M, Vernooij-Dassen M, Barach P, Kalkman C, Flink M, Ön G, Olsson M, Bergenbrant S, Orrego C, Suñol R, Toccafondi G, Venneri F, Dudzik-Urbaniak E, Kutryba B, Schoonhoven L, Wollersheim H, on behalf of the European HANDOVER Research Collaborative (2014) Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC Health Services Research 14, 389.
| Crossref | Google Scholar | PubMed |

Hickey A, Horgan F, O’Neill D, McGee H, on behalf of the Steering Committee of the Irish National Audit of Stroke Care (INASC) (2012) Community-based post-stroke service provision and challenges: a national survey of managers and inter-disciplinary healthcare staff in Ireland. BMC Health Services Research 12(1), 111.
| Crossref | Google Scholar | PubMed |

Huijg JM, Gebhardt WA, Dusseldorp E, Verheijden MW, van der Zouwe N, Middelkoop BJ, Crone MR (2014) Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework. Implementation Science 9(1), 33.
| Crossref | Google Scholar |

Intercollegiate Stroke Working Party (2023) National Clinical Guideline for Stroke for the UK and Ireland. (Intercollegiate Stroke Working Party: London, UK) Available at www.strokeguideline.org

Johnson MJ, May CR (2015) Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. BMJ Open 5(9), e008592.
| Crossref | Google Scholar | PubMed |

Johnston SC, Sidney S, Hills NK, Grosvenor D, Klingman JG, Bernstein A, Levin E (2010) Standardized discharge orders after stroke: results of the quality improvement in stroke prevention (QUISP) cluster randomized trial. Annals of Neurology 67(5), 579-589.
| Crossref | Google Scholar | PubMed |

Jones SP, Auton MF, Burton CR, Watkins CL (2008) Engaging service users in the development of stroke services: an action research study. Journal of Clinical Nursing 17(10), 1270-1279.
| Crossref | Google Scholar | PubMed |

Kable A, Baker A, Pond D, Southgate E, Turner A, Levi C (2019) Health professionals’ perspectives on the discharge process and continuity of care for stroke survivors discharged home in regional Australia: a qualitative, descriptive study. Nursing & Health Sciences 21(2), 253-261.
| Crossref | Google Scholar | PubMed |

Kind AJ, Thorpe CT, Sattin JA, Walz SE, Smith MA (2012) Provider characteristics, clinical-work processes and their relationship to discharge summary quality for sub-acute care patients. Journal of General Internal Medicine 27(1), 78-84.
| Crossref | Google Scholar | PubMed |

Lindblom S, Ytterberg C, Elf M, Flink M (2020) Perceptive dialogue for linking stakeholders and units during care transitions – a qualitative study of people with stroke, significant others and healthcare professionals in Sweden. International Journal of Integrated Care 20(1), 11.
| Crossref | Google Scholar | PubMed |

Luker J, Grimmer-Somers K (2009) The relationship between staff compliance with implementing discharge planning guidelines, and stroke patients’ experiences post-discharge. Internet Journal of Allied Health Sciences and Practice 7(3), Article 11.
| Crossref | Google Scholar |

Lynch EA, Luker JA, Cadilhac DA, Fryer CE, Hillier SL (2017) A qualitative study using the Theoretical Domains Framework to investigate why patients were or were not assessed for rehabilitation after stroke. Clinical Rehabilitation 31(7), 966-977.
| Crossref | Google Scholar | PubMed |

Lynch EA, Mackintosh S, Luker JA, Hillier SL (2019) Access to rehabilitation for patients with stroke in Australia. The Medical Journal of Australia 210(1), 21-26.
| Crossref | Google Scholar | PubMed |

Magdon-Ismail Z, Sicklick A, Hedeman R, Bettger JP, Stein J (2016) Selection of postacute stroke rehabilitation facilities: a survey of discharge planners from the Northeast Cerebrovascular Consortium (NECC) region. Medicine (Baltimore) 95(16), e3206.
| Crossref | Google Scholar | PubMed |

McCann L, Groot P, Charnley C, Gardner A (2009) Excellence in regional stroke care: an evaluation of the implementation of a stroke care unit in regional Australia. Australian Journal of Rural Health 17(5), 273-278.
| Crossref | Google Scholar | PubMed |

McDonald K, Sundaram V, Bravata D, et al. (2007) ‘Definitions of Care Coordination and Related Terms. Vol. 7.’ (Agency for Healthcare Research and Quality)

Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A (2005) Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality & Safety in Health Care 14(1), 26-33.
| Crossref | Google Scholar | PubMed |

Mountain A, Patrice Lindsay M, Teasell R, Salbach NM, de Jong A, Foley N, Bhogal S, Bains N, Bowes R, Cheung D, Corriveau H, Joseph L, Lesko D, Millar A, Parappilly B, Pikula A, Scarfone D, Rochette A, Taylor T, et al. (2020) Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation following Stroke. Part Two: Transitions and Community Participation Following Stroke. International Journal of Stroke 15(7), 789-806.
| Crossref | Google Scholar | PubMed |

Perry L, Middleton S (2011) An investigation of family carers’ needs following stroke survivors’ discharge from acute hospital care in Australia. Disability and Rehabilitation 33(19-20), 1890-1900.
| Crossref | Google Scholar | PubMed |

Phillips CJ, Marshall AP, Chaves NJ, Jankelowitz SK, Lin I, Loy CT, Rees G, Sakzewski L, Thomas S, To T-P, Wilkinson S, Michie S (2015) Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study. Journal of Multidisciplinary Healthcare 2015, 139-146 10.2147/JMDH.S78458.
| Google Scholar |

Reeves MJ, Fritz MC, Woodward AT, Hughes AK, Coursaris CK, Swierenga SJ, Nasiri M, Freddolino PP (2019) Abstract 119: Final Patient-Level Results From the Michigan Stroke Transitions Trial (MISTT): A Randomized Clinical Trial to Improve Stroke Transitions. Stroke (1970) 50(Suppl_1), A119.
| Crossref | Google Scholar |

Røsstad T, Garåsen H, Steinsbekk A, Sletvold O, Grimsmo A (2013) Development of a patient-centred care pathway across healthcare providers: a qualitative study. BMC Health Services Research 13(1), 121.
| Crossref | Google Scholar |

Sadeh-Sharvit S, Rego SA, Jefroykin S, Peretz G, Kupershmidt T (2022) A Comparison Between Clinical Guidelines and Real-World Treatment Data in Examining the Use of Session Summaries: Retrospective Study. JMIR Formative Research 6(8), e39846.
| Crossref | Google Scholar | PubMed |

Schreier M (2014) Ways of doing qualitative content analysis: disentangling terms and terminologies. Forum Qualitative Social Research 15(1), 146-155.
| Crossref | Google Scholar |

Sheehan J, Lannin NA, Laver K, Reeder S, Bhopti A (2022) Primary care practitioners’ perspectives of discharge communication and continuity of care for stroke survivors in Australia: a qualitative descriptive study. Health and Social Care in the Community 30(5), e2530-e2539.
| Crossref | Google Scholar | PubMed |

Shepperd S, McClaran J, Phillips CO, Lannin NA, Clemson LM, McCluskey A, Cameron ID, Barras SL (2010) Discharge planning from hospital to home. Cochrane Database of Systematic Reviews [1] CD000313.
| Crossref | Google Scholar | PubMed |

Smith JD, Corace KM, MacDonald TK, Fabrigar LR, Saedi A, Chaplin A, MacFarlane S, Valickis D, Garber GE (2019) Application of the Theoretical Domains Framework to identify factors that influence hand hygiene compliance in long-term care. Journal of Hospital Infection 101(4), 393-398.
| Crossref | Google Scholar | PubMed |

Stroke Foundation (2017) Clinical Guidelines for Stroke Management 2017. Available at https://informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Management

Stroke Foundation (2019) My Stroke Journey. Available at https://strokefoundation.org.au/What-we-do/Support-programs/My-Stroke-Journey

Stroke Foundation (2023) Living clinical guidelines for stroke management. Available at https://informme.org.au/guidelines/living-clinical-guidelines-for-stroke-management

Waring J, Bishop S, Marshall F (2016) A qualitative study of professional and carer perceptions of the threats to safe hospital discharge for stroke and hip fracture patients in the English National Health Service. BMC Health Services Research 16(1), 297.
| Crossref | Google Scholar |

Waring J, Bishop S, Marshall F, Tyler N, Vickers R (2019) An ethnographic study comparing approaches to inter-professional knowledge sharing and learning in discharge planning and care transitions. Journal of Health Organization and Management 33(6), 677-694.
| Crossref | Google Scholar | PubMed |