Assessment of Safe Discharge at Hospice Sydfyn

Hospice Sydfyn has, through the initiative “Safe Discharge,” worked to strengthen cooperation around the discharge of patients in order to ensure a safe transition from hospice to home/care centre.

AIM

The high discharge percentage places great demands on interdisciplinary and cross-sectoral coordination. Safe Discharge has led to the establishment of several initiatives, including cross-sectoral conferences (CSC), calls to patients the day after discharge and Hospice Hotline. Previous evaluations of the initiative have shown positive results, where both patients and relatives feel safe during the discharge. The purpose of this project was to shed light on Hospice Sydfyn’s partners’ experiences of the initiative and identify potentials for future strengthening of the cooperation.

A total of 25 partners participated in the study. In connection with 13 CSCs, 16 semi-structured interviews were held with partners from three municipalities and Palliative Team Funen, and a workshop was held where 13 participants jointly qualified and nuanced the preliminary findings.

RESULTS

Hospice Sydfyn’s partners generally expressed great satisfaction with the cooperation, including the cross-sectoral conferences, which were assessed as central to promoting coordination, coherence and safety in connection with the discharge of patients.

There proved to be a fair amount of preparation associated with CSCs. Most participants generally experienced good and detailed care pathway plans, but at the same time they needed a clear agenda and specific information about the patient’s functional abilities, so that they could involve relevant professional sparring or participation.

The partners suggested a more flexible notice of CSC, depending on the complexity of the patient’s situation. The participants in the workshop pointed to a need to strengthen the meeting leader’s competencies related to meeting facilitation, and to have fixed meeting leaders, as meeting facilitation could be experienced as particularly difficult when discharge was not desired by patients and relatives. The time frame of half an hour was often sufficient, but there was a need to assess it individually, depending on the patient’s situation.

A need was expressed for the meeting leader to prepare a shared record, which is shared with both partners, patients and relatives after the completed CSC. This will increase transparency and reduce the risk of misunderstandings. It was the partners’ experience that Hospice Sydfyn’s call to the patient the day after discharge creates safety and is generally appreciated.

In addition, it was pointed out that preparing a description of the cross-sectoral workflows associated with discharges can provide an overview of which central coordinations the involved parties must address, and serve as a shared frame of reference for their future cooperation.

PARTNERS

• Hospice Sydfyn
• Faaborg Midtfyn Municipality
• Langeland Municipality
• Svendborg Municipality
• Palliative Team, OUH

CIMT was responsible for the assessment of the partners’ experience.

If you are interested in reading the final assessment report, please contact Kathrine Rayce.