Long-Stay Views from the Hospital Bed: Patient Perspectives of Organisation of Care and Impact of Hospitalisation

Article excerpt

Abstract

This study aimed to determine the perspectives of a group of patients categorised as "long-stay outliers" at a large South Australian metropolitan hospital about aspects of organisation of care and the perceived impact of long-term hospitalisation. Nineteen patients were interviewed using a semi-structured questionnaire. Eighty-nine percent of participants stated that they had no knowledge of how long they were to be in hospital. Forty-two percent indicated that they did not know when they would be discharged from hospital. This was of concern, especially considering the vulnerability of this patient group and the known benefits of patient involvement in decision making and the improvements this can make to health outcomes and early discharge. Participants indicated concern about sleep deprivation, diet, ability to return to paid employment, and missing their family as the main areas of impact of their long hospitalisation. Concerns about being discharged from hospital included: apprehension as to whether they were well enough to leave; the recurrence of infection; whether they would be able to sleep well when they got home; their recent loss of appetite and associated weight loss; mobility concerns; and what supports they would have when they were discharged home. All these issues require staff to be more patient and family-centred in their approach to preparing for discharge.

Aust Health Rev 2005: 29(2): 235-240

INCREASED DEMAND and patients requiring longterm admission have impacted significantly on access to hospitals. Patients who have longer stays than determined by casemix formulas for specific conditions are termed "long-stay outliers". The long-stay outlier population at a large metropolitan tertiary referral hospital in South Australia had been analysed from many perspectives, but patient perspectives had not been considered. It was suggested that seeking patient perspectives on factors contributing to and associated with their length of stay may identify additional strategies to improve management of these patients and assist in understanding the impact on this patient group and their families.1 Patient feedback and involvement in decision making about care is a priority area for action and is strongly integrated into the safety and quality agenda in Australia being led by the Australian Council for Safety and Quality in Health Care (http://www.safetyandquality.org).

Emerging evidence supports patient participation in health, demonstrating that active patient participation in decision making in individual care leads to improvements in health outcomes and that access to quality information facilitates decision making. This supports an active role for patients and carers in managing care.2 The purpose of this study was to provide a long-stay outlier patient perspective into the organisation of care and the impact of their long-term hospitalisation.

Method

Patient interviews

Information was collected by semi-structured individual face-to-face interviews during the hospital admission (see Box 1 for the list of questions asked). An experienced consumer interviewer (RC) was employed to conduct the patient interviews. Notes were taken during the interviews and additional information was added after the interviews to ensure comprehensive records were made of each interview.

Hospital inpatients with a length of stay between 14 and 30 days were identified over a 9-day period in March 2003 from a daily list of long-stay outliers produced by the hospital's Department of Clinical Epidemiology Length of stay of between 14 and 30 days was specified as it was the hospital definition, at that time, of a "long-stay outlier". The month of March was selected for this study as it was a specified period of time which would be compatible with other clinical epidemiological studies related to the long-stay outlier issue which were being conducted by the Department of Clinical Epidemiology

Potential participants were selected according to the following inclusion criteria. …