Insights identifying priorities from providers and patients to optimize a vascular surgery hospital discharge: A qualitative study

Abstract

Objective

Hospital discharge is complex and requires care coordination of multiple disciplines. We evaluated perspectives and priorities of individual stakeholders involved in the vascular discharge process. This study aimed to identify barriers to an informed and cohesive discharge process based on individual stakeholders (physicians, advanced practitioners nurses, ancillary staff, patients, and families) perceptions.

Methods

Single center, qualitative analysis using a semi-structured focus group interview guide based on the validated hospital-based Reengineered Discharge (RED) process. Focus groups were audio-recorded, transcribed into text files, independently coded, and analyzed with Dedoose qualitative software using a directed content analysis approach. Thematic concepts were created and comparisons between groups was performed.

Results

Eight focus groups with 38 participants were convened. Participants included physics / advanced practice providers (n=12), nursing / ancillary staff (n=19), and patients / caregivers (N=6) Key themes affecting. Discharge for vascular surgery patients varied by group. Physicians cited low health literacy, poor understanding of discharge instructions, social determinants of health, and medical complexity as major barriers. Staff identified time constraints, medication access, and inter team communication as primary challenges. Patients highlighted complex discharge instructions, COVID-19’s impact on support systems, and technology barriers.

Conclusions

Healthcare providers and patients identified very different priorities regarding an optimized discharge. Physicians were most concerned with low patient understanding of impeding discharge. Nursing staff identified obtaining medications, inter-team communication, and time constraints as their greatest obstacles. Patients found the impact of COVID-19, lack of support systems, and accessing technology as the most difficult. These findings underscore the need for tailored interventions to improve the discharge process which account for individual stakeholders’ priorities to develop a national standardized “patient-centered” discharge process for patients with vascular disease.