title: Clinicians' perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma.
abstract: Objective The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma. Methods A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews. Results Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients' requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer. Conclusions The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making. What is known about the topic? Little is known about the drivers for referral to, or acceptance at, in-patient rehabilitation following acute hospital care for traumatic injury in Victoria, Australia, including who makes these decisions of behalf of patients and how these decisions are made. What does this paper add? This paper provides information regarding the perceptions of acute hospital consultant surgeons and allied health, as well as rehabilitation clinicians, in terms of discharge destination decision making from the acute hospital following trauma. The use of case studies further highlights differences between, and within, these specialities with regard to this decision making. This research also highlights the importance of financial considerations as drivers of decision making, and the lack of consistency of the factors thought to be important drivers of discharge between these different clinical groupings. What are the implications for practitioners? This research shows that financial factors are significant drivers of discharge destination decision making for trauma patients. The present study highlights opportunities to engage with stakeholders (acute care, rehabilitation, administration, government and patients) to develop more consistent discharge processes that optimise the use of rehabilitation resources for those patients who could benefit from in-patient rehabilitation.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Vic. 3004, Australia. Email:.
authors.forename: Lara A
authors.initials: LA
authors.lastname: Kimmel
authors.affiliation: School of Allied Health, La Trobe University, Vic. 3086, Australia. Email:.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Holland
authors.affiliation: School of Allied Health, La Trobe University, Vic. 3086, Australia. Email:.
authors.forename: Natasha
authors.initials: N
authors.lastname: Lannin
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Vic. 3004, Australia. Email:.
authors.forename: Elton R
authors.initials: ER
authors.lastname: Edwards
authors.affiliation: Department of Orthopaedics, Barwon Health and St John of God, Geelong, Vic. 3220, Australia. Email.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Page
authors.affiliation: Department of Orthopaedics, Royal Melbourne Hospital, Melbourne, Vic. 3050, Australia. Email.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bucknill
authors.affiliation: Department of Orthopaedics, Northern Hospital, Epping, Vic. 3076, Australia. Email.
authors.forename: Raphael
authors.initials: R
authors.lastname: Hau
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Vic. 3004, Australia. Email:.
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
mesh_terms: D003657:Decision Making; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000523:psychology*; D010351:Patient Discharge; D036301:Qualitative Research; D012047:Rehabilitation Centers; D014739:Victoria; D014947:Wounds and Injuries / Q000534:rehabilitation*