An evidence-informed approach to discharge planning from specialist brain injury rehabilitation: a mixed method study using the PRECEDE–PROCEED model

Liana S. Cahill; Lauren J. Christie; Danielle Sansonetti; Suzanne Currie; Mithu Palit; Nita Robin Jacob; Daniella Leifer; Natasha A. Lannin

doi:10.1071/IB24029

RESEARCH ARTICLE (Open Access)

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An evidence-informed approach to discharge planning from specialist brain injury rehabilitation: a mixed method study using the PRECEDE–PROCEED model

Liana S. Cahill

^A ^B ^* , Lauren J. Christie ^C ^D ^E , Danielle Sansonetti ^B , Suzanne Currie ^B , Mithu Palit ^B , Nita Robin Jacob ^B , Daniella Leifer ^B and Natasha A. Lannin

^B ^F

+ Author Affiliations

- Author Affiliations

^A School of Allied Health, Australian Catholic University, Melbourne, Vic, Australia.

^B Allied Health, Alfred Health, Melbourne, Vic, Australia.

^C Allied Health Research Unit, St Vincent’s Health Network Sydney, Darlinghurst, NSW, Australia.

^D School of Allied Health, Australian Catholic University, North Sydney, NSW, Australia.

^E Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Darlinghurst, NSW, Australia.

^F Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Vic, Australia.

^* Correspondence to: natasha.lannin@monash.edu

Handling Editor: Grahame Simpson

Brain Impairment 26, IB24029 https://doi.org/10.1071/IB24029

Submitted: 12 April 2024 Accepted: 26 April 2025 Published: 27 May 2025

© 2025 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

The transition from inpatient rehabilitation to community living is a challenging time for adults with acquired brain injury (ABI). This study aimed to investigate barriers to evidence-based discharge practices in inpatient ABI rehabilitation and to collaboratively design implementation solutions with rehabilitation healthcare professionals.

Method

We used a theoretical problem-analysis approach guided by the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) – Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) model. Participants were healthcare professionals working in inpatient ABI rehabilitation and external stakeholders working with patients with ABI post-discharge. Triangulation of data and methods (audits, surveys, focus groups) were employed to provide a comprehensive analysis of barriers and their causes.

Results

A total of 47 healthcare professionals (70% female) and 14 external stakeholders (71% female) participated. Factors negatively impacting on discharge were classified as pre-disposing (inconsistent planning, limited staff knowledge of discharge goals), enabling (accommodation and funding) and reinforcing (communication, family, nursing involvement). Suggested facilitators for coordinated discharge included clear and consistent communication, support for patient-family emotional adjustment to disability and discharge plans, and improved early access to funding schemes.

Conclusion

Theory-informed and collaborative methods led to recommendations including a discharge pathway and checklist, meetings with clear objectives for discharge discussions, and an increase in family and nursing staff involvement to improve discharge processes.

Keywords: health services research, implementation science, models (theoretical), occupational therapy, patient discharge, rehabilitation, stroke, traumatic brain injury.

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