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

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.