Hospital discharge planning: a qualitative study of new-graduate physiotherapists' experiences
Purpose: Discharge planning constitutes a large part of a physiotherapist's role when working in hospital settings. The challenges of decision-making relating to discharge planning have been identified by experienced physiotherapists. Despite known challenges associated with the transition from student to clinician, the experiences of new-graduates undertaking discharge planning are largely unknown. Therefore, this study aimed to explore:
1) new-graduate physiotherapists' experiences of discharge planning in hospital settings, and
2) the influence of pre-professional training on their perceived preparedness for discharge planning.
Design: A qualitative general inductive approach using semi-structured interviews. New-graduate physiotherapists (n = 14) working in hospital settings were recruited.
Finding: Four themes were generated: 1) responding to the pressures associated with discharging patients, 2) complex decision-making, 3) the role of the interprofessional team, and 4) desiring additional context and complexity from pre-professional training.
Practice Implications: The study has identified that new-graduates underestimate the extent to which discharge planning features in their roles within hospital settings, and are unaware of the interprofessional practice required. Whilst they felt that their pre-professional training provides the technical skills required for their roles, they felt that they were not prepared for their role within the broader healthcare system, nor the complexity of clinical practice. This study encourages education providers to emphasise the role of physiotherapists within the broader health care system, through highlighting contexts where physiotherapy knowledge can be applied (i.e., discharge planning) and understanding the role of the physiotherapist within the interprofessional team.
Limitations: Important perspectives of mentors and other members of the interprofessional team involved in discharge planning have not been included in this study which may have impacted the interpretation of the results.
Atwal, A, McIntyre, A & Wiggett, C 2012, 'Risks with older adults in acute care settings: UK occupational therapists’ and physiotherapists’ perceptions of risks associated with discharge and professional practice', Scand J Caring Sci, vol. 26, no. 2, pp. 381-93.
Barradell, S, Peseta, T & Barrie, S 2018, '‘There’s so much to it’: the ways physiotherapy students and recent graduates experience practice', Adv Health Sci Educ Theory Pract, vol. 23, no. 2, pp. 387-406.
Bowling, A & Ebrahim, S 2001, 'Measuring patients' preferences for treatment and perceptions of risk', Qual Health Care, vol. 10, no. suppl 1, pp. i2-i8.
Cheng, C-Y, Tsai, H-M, Chang, C-H & Liou, S-R 2014, 'New Graduate Nurses’ Clinical Competence, Clinical Stress, and Intention to Leave: A Longitudinal Study in Taiwan', The Scientific World Journal, vol. 2014, p. 748389.
Chipchase, LS, Williams, MT & Robertson, VJ 2008, 'Preparedness of new graduate Australian physiotherapists in the use of electrophysical agents', Physiotherapy, vol. 94, no. 4, pp. 274-80.
Durocher, E, Gibson, BE & Rappolt, S 2017, 'Mediators of marginalisation in discharge planning with older adults', Ageing and Society, vol. 37, no. 9, pp. 1747-69.
Durocher, E, Kinsella, EA, Ells, C & Hunt, M 2015, 'Contradictions in client-centred discharge planning: through the lens of relational autonomy', Scand J Occup Ther, vol. 22, no. 4, pp. 293-301.
Englander, M 2016, 'The phenomenological method in qualitative psychology and psychiatry', International journal of qualitative studies on health and well-being, vol. 11, no. 1, pp. 30682-11.
Forbes, R & Ingram, M 2019, 'New-graduate physiotherapists’ readiness for practice and experiences of managing chronic pain
a qualitative study', Physiotherapy Theory and Practice, no. Decemeber #1, pp. 1-8.
Forbes, R, Lao, A, Wilesmith, S & Martin, R 2021, 'An exploration of workplace mentoring preferences of new‐graduate physiotherapists within Australian practice', Physiother Res Int, vol. 26, no. 1, pp. e1872-n/a.
Frost, FS 2001, 'Rehabilitation and fear: What happens if the house catches on fire?', Am J Phys Med Rehabil, vol. 80, no. 12, pp. 942-4.
Goldman, J, Reeves, S, Wu, R, Silver, I, MacMillan, K & Kitto, S 2016, 'A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning', J Interprof Care, vol. 30, no. 2, pp. 217-25.
Health Workforce Australia 2014, Australia’s Health Workforce Series – Physiotherapists in Focus. , Australian Government, <http://iaha.com.au/wp-content/uploads/2014/03/HWA_Australia-Health-Workforce-Series_Physiotherapists-in-focus_vF_LR.pdf>.
Jette, D, Grover, L & Keck, C 2003, 'A Qualitative Study of Clinical Decision Making in Recommending Discharge Placement From the Acute Care Setting', Phys Ther, vol. 83, no. 3, pp. 224-36.
Jones, A, Ingram, ME & Forbes, R 2020, 'Physiotherapy new graduate self-efficacy and readiness for interprofessional collaboration: a mixed methods study', Journal of interprofessional care, vol. ahead-of-print, no. ahead-of-print, pp. 1-10.
Kraft, A, Wise, H, Jacques, P & Burik, J 2013, 'Discharge Planning Simulation: Training the Interprofessional Team for the Future Workplace', Journal of allied health, vol. 42, no. 3, p. 175.
Lati, J, Pellow, V, Sproule, J, Brooks, D & Ellerton, C 2014, 'Examining interrater reliability and validity of a paediatric cardiopulmonary physiotherapy discharge tool', Physiother Can, vol. 66, no. 2, pp. 153-9.
Lobchuk, M, Bell, A, Hoplock, L & Lemoine, J 2021, 'Interprofessional discharge team communication and empathy in discharge planning activities: A narrative review', Journal of interprofessional education & practice, vol. 23, p. 100393.
Martin, R, Mandrusiak, A, Lu, A & Forbes, R 2020, 'New‐graduate physiotherapists' perceptions of their preparedness for rural practice', The Australian journal of rural health, vol. 28, no. 5, pp. 443-52.
Martin, R, Mandrusiak, A, Russell, T & Forbes, R 2021, 'New-graduate physiotherapists’ training needs and readiness for telehealth.', Physiotherapy Theory and Practice, vol. Accpeted: In-press.
Mathew, SA, Heesch, KC, Gane, E & McPhail, SM 2015, 'Risk factors for hospital re-presentation among older adults following fragility fractures: protocol for a systematic review', Syst Rev, vol. 4, no. 1, pp. 91-.
Mizuma, K, Amitani, M, Mizuma, M, Kawazu, S, Sloan, RA, Ibusuki, R, Takezaki, T & Owaki, T 2020, 'Clarifying differences in viewpoints between multiple healthcare professionals during discharge planning assessments when discharging patients from a long-term care hospital to home', Evaluation and program planning, vol. 82, p. 101848.
Patton, M 2002, Qualitative Research and Evaluation Method, 3rd end, Sage Publications, California.
Pitas, A 2017, 'Dischargology: the integration of capacity and demand, caseload management and discharge planning', Physiotherapy, vol. 103, pp. e68-e.
Potthoff, S, Kane, RL & Franco, SJ 1997, 'Improving hospital discharge planning for elderly patients', Health Care Financ Rev, vol. 19, no. 2, pp. 47-72.
Robertson, B, McDermott, C, Star, J, Lewin, LO & Spell, N 2021, 'Synchronous virtual interprofessional education focused on discharge planning', J Interprof Educ Pract, vol. 22, pp. 100388-.
Smith, LM, Keiser, M, Turkelson, C, Yorke, AM, Sachs, B & Berg, K 2018, 'Simulated Interprofessional Education Discharge Planning Meeting to Improve Skills Necessary for Effective Interprofessional Practice', Prof Case Manag, vol. 23, no. 2, pp. 75-83.
Smith, M, Joy, H & Ellis, E 2010, 'Effect of experience on clinical decision making by cardiorespiratory physiotherapists in acute care settings', Physiotherapy Theory and Practice, vol. 26, no. 2, pp. 89-99.
Stoikov, S, Maxwell, L, Butler, J, Shardlow, K, Gooding, M & Kuys, S 2020, 'The transition from physiotherapy student to new graduate: are they prepared?', Physiotherapy theory and practice, pp. 1-11.
Stokes, CK, Lysaght, C, Kim, Y, Lin, C-C, Murphy, L & Radloff, JC 2020, 'Influence of interprofessional communication on discharge decisions in prelicensure healthcare learners', Journal of interprofessional education & practice, vol. 19, p. 100329.
Taylor, NF, Harding, KE, Dowling, J & Harrison, G 2010, 'Discharge planning for patients receiving rehabilitation after hip fracture: A qualitative analysis of physiotherapists' perceptions', Disability and Rehabilitation, vol. 32, no. 6, pp. 492-9.
Varpio, L, Ajjawi, R, Monrouxe, LV, O'Brien, BC & Rees, CE 2017, 'Shedding the cobra effect: problematising thematic emergence, triangulation, saturation and member checking', Med Educ, vol. 51, no. 1, pp. 40-50.
Worley, A, Barras, S & Grimmer-Somers, K 2010, 'Falls are a fact of life for some patients after discharge from a rehabilitation programme', Disabil Rehabil, vol. 32, no. 16, pp. 1354-63.
Yu, PMD, Chang, DC, Osen, HB & Talamini, M 2011, 'NSQIP Reveals Significant Incidence of Death Following Discharge', J Surg Res, vol. 170, no. 2, pp. e217-e24.