Volume 24, Issue 1 (Spring 2018)                   IJPCP 2018, 24(1): 56-69 | Back to browse issues page

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Toufighi H, Sharifi V, Alaghband Rad J, Shadloo B. Development and Implementation of Discharge Planning Service in Roozbeh Hospital. IJPCP. 2018; 24 (1) :56-69
URL: http://ijpcp.iums.ac.ir/article-1-2593-en.html
1- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
2- Department of Psychiatry, Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
3- Department of Psychiatry, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran , Email: behrang.shadloo@gmail.com
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Extended Abstract
1. Introduction

Psychiatric disorders have a high prevalence and impose a huge burden to societies all over the world. Despite the recent trend to develop community-based psychiatry services, hospital-based services are still an inevitable part of treatment process, especially for patients in acute phases. Nowadays, interventions focusing on the transition phase from inpatient to outpatient are gaining increasing attention. Each patient, after discharge from psychiatric inpatient ward, needs to be monitored for optimum adherence to outpatient pharmacological and non-pharmacological services. Discharge planning is a dynamic, collaborative and comprehensive process, which is aimed to promote the continuity of care after discharge and providing necessary services and support to the client and his/her caregivers. Recently, the efficacy of discharge planning has been shown in multiple studies on factors like re-admission, treatment adherence, length of stay, treatment costs, symptoms resolution and patients’ quality of life. In line with the above, we decided to develop and implement a discharge planning service in Roozbeh Hospital.
2. Method 
We used an evidence-based service development model which contained five steps, including needs assessment, situation analysis, cost-effectiveness evaluation, prioritization and structural design. In the first step, the researchers must perform a comprehensive review of literature in the target field, to estimate the level of necessity of the service for their goal. The second step contains the assessment of the current level of the services provided in the field, based on some standard indices. Cost-Effectiveness study of the service comes after that, and in the fourth step the researcher must prioritize the possible suggested interventions based on indicators like the burden of disease, cost-effectiveness, feasibility and affordability. 
At the end, developing the service structure, process and details would happen. This is worth to mention that some authors refer to the fourth and fifth steps together as the implementation phase. Implementation is also defined as a series of specific activities directed to make a program with specific features work. This process contains determining the criteria for staff selection and education, providing pre-requisites, forms and devices, determining the data registry system, providing educational material, and choosing the corresponded and coordinator individuals for each step. The review of literature has been performed using international scientific databases including Medline, Elsevier and Cochrane; and domestic databases including Noormags, Magiran, SID and Medlib. The search performed on keywords including discharge planning, patient management, case management, service development, service implementation, and service planning, in English and Persian, with no time or study design restriction.
3. Results
In brief, the majority of references found the discharge planning service efficient on improving factors like re-admission rate, treatment adherence, length of stay, costs of the treatment, symptom resolution, quality of life, suicide rate, and patients’ satisfaction. Needs assessment studies and situation analysis showed that Roozbeh Hospital had some deficits in both measured indicators. Based on the Health Information System of the hospital, we reviewed the adherence of the discharged patients to their outpatient visit, with more than half (56%) of the patients had no outpatient follow-up visit after discharge, and 37% had come just one time. Although 44% of our patients showed some degrees of follow-up visit adherence and it is about the average (21-76%) in other centers, this could be improved up to 47-95% like the centers developed discharge planning services. The other indicator was the length of stay, and its mean in Roozbeh Hospital (Based on the HIS data) was 28 days, and is above the national average (20.7 days), and far from other countries like Belgium (10.2 days), Italy (13.9 days) and Turkey (15 days).
In the next step, prioritization among possible interventions and designing the structure and details of this service in Roozbeh Hospital performed based on special needs of the center and feasibility of services, considering the principles mentioned in the literature such as continuity of care, availability of the service, comprehensiveness of domains, maximal patient and his/her family collaboration, and the patients’ individuality. Finally, a discharge planning program designed which includes following steps: patient data registration, needs assessment, coordinating services and checklists of the services. Although the discharge planning is a team-based service which includes the psychiatrist, psychologist, social worker, nurse, day center staff, and surely the patient and his/her caregivers, every patient would have a specific contact-person called treatment mediator, whom is one of the nurses of the admission ward. 
The content of discharge planning service in the time of admission ideally includes four sessions. The session zero contains welcoming the patient by the nurse and reminding the ward rules. The first session would be on needs assessment and planning for them, and the second session would be on specific educations for the patient and the caregivers. In the last session at the time of discharge, the forms and checklists will be fulfilled.
4. Discussion 
Discharge planning service development is proven to be efficient in many ways, and even seems to be an ethical necessity. We had some limitations in our study such as lacking a good relationship with extra-organizational structures and social support systems, and having no prior experience in this field in the country. Meanwhile, the results of integration of the service in other services of the hospital would be gathered and published later. Development and implementation of the discharge planning service has been performed for the first time in Iran, in Roozbeh Hospital and requires to be evaluated and revised continuously, and we hope that this program be prominent to other psychiatric inpatient centers and also higher order mental health organizations.
This paper was extracted from the PhD dissertation of the first author in Psychiatry and Psychology Research Center, Tehran University of Medical Sciences. We wish to thank Dr. Zahra Mirsepasi, Dr. Valentin Artounian, Dr. Fatemeh Ranjbar-Kermani and the staff of Roozbeh Hospital day center for their invaluable contribution in our study.
Conflict of Interest
The authors declare no conflicts of interest.

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Type of Study: Scientific Report | Subject: Psychiatry and Psychology
Received: 2016/11/7 | Accepted: 2017/06/19 | Published: 2018/04/1

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