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1 – 10 of over 19000Daisy Alicia Gibson, Holly Eick, Susanne Meddings and Ceri Woodrow
This paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line…
Abstract
Purpose
This paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line with the transforming care agenda.
Design/methodology/approach
This is a retrospective evaluation of 44 admissions and discharges from two ATUs from February 2019 to March 2022.
Findings
Of 44 admissions who were discharged during the included period, 20 experienced delays in their discharge. Delayed discharges occurred despite the two ATUs meeting standards for length of assessment and treatment as specified by the Learning Disability Professional Senate. The most prevalent reasons for discharge delays were identification of a new placement, recruitment of care staff and building work.
Originality/value
This paper offers an in-depth evaluation of recent delayed discharges from two regional ATUs, highlighting the most common reasons for delays and offering suggestion for reducing delays in future.
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Isobel Moore, Philip John Archard and Sarah Simmonds
The process of ending mental health support is often not well-attended to in practice or research, and clinicians in UK mental health services lack focused clinical guidance in…
Abstract
Purpose
The process of ending mental health support is often not well-attended to in practice or research, and clinicians in UK mental health services lack focused clinical guidance in this area. This paper aims to report on a service evaluation that sought to understand from clinicians working in a single adult community mental health team (CMHT) their experiences of discharge and issues arising in the process, factors considered in decision-making and what constitutes “good” endings and what support could be helpful to them in navigating this with clients.
Design/methodology/approach
Semi-structured interviews were completed with six members of the multi-disciplinary team and analysed thematically.
Findings
Clinicians described a range of criteria considered in discharge decision-making. Collaboration, planning and preparation were represented as key ingredients for “good” endings. Factors viewed as complicating discharge included complexity and changes in presentation, psychosocial contexts and re-referrals. Perceptions of clients’ feelings (resistance and dependence, fear and anger, relief and gratitude) and varying feelings evoked for clinicians (from little or no reported impact, to pride and confidence, sadness and worry) at the ending of the working relationship were reported. Suggested organisational supports for clinicians with endings and discharges involved opportunities to consult with colleagues, psychological formulation and advice and reflective supervision.
Originality/value
There has been limited empirical attention to practitioner experiences of discharge in the work of CMHTs in a UK context; this practitioner-led evaluation explored clinician perspectives.
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This article reports on the experiences and evaluations of piloting health and social care discharge co‐ordinators in acute and community hospital settings. Benefits were felt…
Abstract
This article reports on the experiences and evaluations of piloting health and social care discharge co‐ordinators in acute and community hospital settings. Benefits were felt with regard to length of stay, bed day use, and patient and staff experience, and were particularly notable where a discharge co‐ordinator employed by the community trust was put into the acute hospital setting. The pilots have supported a redesign of hospital discharge processes across Torbay Care Trust and South Devon Healthcare NHS Foundation Trust, and provided the foundation for improved partnership working and integrated service provision.
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Djazia Khelil, Slimane Bouazabia and Pantelis N. Mikropoulos
The paper aims to estimate the instantaneous breakdown voltage of the lightning discharge from simulated figures in an energized rod-plane configuration protected by a lightning…
Abstract
Purpose
The paper aims to estimate the instantaneous breakdown voltage of the lightning discharge from simulated figures in an energized rod-plane configuration protected by a lightning rod. The same configuration of electrodes has been the subject of experimental investigations for the measurement of the instantaneous breakdown voltage using oscillographic monitoring. This study validates the simulation model by making a comparison with experimentation and involves the role of the inception field of the upward discharge in the propagation of this last one.
Design/methodology/approach
The research methodology is based on the development of a fractal lightning protection model based on real physical conditions of the discharge propagation, such as the downward discharge and the upward one emanating from protection. The voltage drop and the randomness character of the lightning discharge are also taken into account. The electrical field is an important parameter in discharge development; it is considered in this work at each step of the discharge propagation by the finite element method. The instantaneous breakdown voltage is measured and estimated by both empirical equations and simulated figures of lightning discharge
Findings
The established model that allows estimating the instantaneous breakdown voltage from simulated discharges and empirical equations gives results in a good agreement with experimentation. The involvement of the upward discharge inception field emanating from the lightning rod in the evolution of electrical discharge is illustrated.
Practical implications
The work presented in this paper aims to develop a new fractal lightning protection model taking into consideration physical phenomena intervening in the development of the lightning discharge.
Originality/value
The originality of this work consists of the combination between fractals modelling of the electrical discharge and the protection against lightning, in addition, to use one of the characteristics of the electrical discharge, which is the instantaneous breakdown voltage, to prove the importance of the inception field emanating from the upward discharge in the propagation criterion of this last one.
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Cinzia Storace, Serafina Esposito, Anna Maria Iannicelli and Carmela Bravaccio
To facilitate the reception and care of discharged patients, streamlining processes at the University Hospital and promoting a seamless transition to continuity of care services…
Abstract
Purpose
To facilitate the reception and care of discharged patients, streamlining processes at the University Hospital and promoting a seamless transition to continuity of care services post-discharge.
Design/methodology/approach
Hospitalised patients undergo the Blaylock risk assessment screening score (BRASS), a screening tool identifying those at risk of complex discharge.
Findings
Pre-pandemic, patients with a medium-to-high risk of complex discharge were predominantly discharged to their residence or long-term care facilities. During the pandemic, coinciding with an overall reduction in hospitalisation rates, there was a decrease in patients being discharged to their residence.
Originality/value
The analysis of discharges, with the classification of patients into risk groups, revealed a coherence between the BRASS score and the characteristics of the studied sample. This tool aids physicians in decision-making by identifying the need for a planned discharge in a systematic and organised manner, preventing the loss of crucial information.
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Kristina Brenisin, Mc Stephen Padilla and Kieran Breen
Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into…
Abstract
Purpose
Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into hospital. There is little research conducted exploring peer support workers’ (PSWs) lived experiences that could provide insight into the key transitions of care, particularly the support required after discharge from inpatient mental health care. The purpose of this paper is thus to provide a particular insight into what it feels like being discharged from psychiatric care from a PSW’s perspective, how may support be improved post-discharge and what factors might impact the potential for readmission into inpatient care.
Design/methodology/approach
A qualitative, phenomenological approach was adopted to explore and describe PSWs’ lived experiences of transitioning from psychiatric care. Four PSWs who were employed by a UK secure mental health facility were recruited. PSW is a non-clinical role with their main duty to support patients, and they were considered for this type of the study for their experience in negotiating the discharge process to better carry out their job as a PSW.
Findings
After being discharged from psychiatric care, PSWs experienced issues that had either a negative impact on their mental wellbeing or even resulted in their readmission back into inpatient psychiatric care. This study identified three inter-related recurrent themes – continuity of support, having options and realisation, all concerning difficulties in adjusting to independent community life following discharge. The findings of the study highlighted the importance of ensuring that service users should be actively involved in their discharge planning, and the use of effective post-discharge planning processes should be used as a crucial step to avoid readmission.
Research limitations/implications
A deeper insight into the factors that impact on readmission to secure care is needed. The active involvement of service users in effective pre- and post-discharge planning is crucial to avoid readmission.
Practical implications
Mental health professionals should consider developing more effective discharge interventions in collaboration with service users; inpatient services should consider creating more effective post-discharge information care and support packages. Their lived experience empowers PSWs to play a key role in guiding patients in the discharge process.
Originality/value
This is the first study, to the best of the authors’ knowledge, to explore what it feels like being discharged from inpatient mental health care by interviewing PSWs employed at a forensic mental health hospital by adopting a phenomenological approach. This paper offers a deeper insight into the transition process and explores in detail what support is needed post discharge to avoid potential readmission from PSWs’ perspectives.
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Chong Xu, Pengbo Wang, Fan Yang, Shaohua Wang, Junping Cao and Xin Wang
This paper aims at building a discharge model for the power cable bellows based on plasma energy deposition and analyzing the discharge ablation problem.
Abstract
Purpose
This paper aims at building a discharge model for the power cable bellows based on plasma energy deposition and analyzing the discharge ablation problem.
Design/methodology/approach
Aiming at the multiphysical mechanism of the discharge ablation process, a multiphysical field model based on plasma energy deposition is established to analyze the discharge characteristics of the power cable bellows. The electrostatic field, plasma characteristics, energy deposition and temperature field are analyzed. The discharge experiment is also carried out for result validation.
Findings
The physical mechanism of the bellows ablative effect caused by partial discharge is studied. The results show that the electric field intensity between the aluminum sheath and the buffer layer easily exceeds the pressure resistance value of air breakdown. On the plasma surface of the buffer layer, the electron density is about 4 × 1,019/m3, and the average temperature of electrons is about 3.5 eV. The energy deposition analysis using the Monte Carlo method shows that the electron range in the plasma is very short. The release will complete within 10 nm, and it only takes 0.1 s to increase the maximum temperature of the buffer layer to more than 1,000 K, thus causing various thermal effects.
Originality/value
Its physical process involves the distortion of electric field, formation of plasma, energy deposition of electrons, and abrupt change of temperature field.
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Kelly Fenton, Katherine Kidd and Alex Lord
The purpose of this study is to assess if the new community-enhanced rehabilitation team reduced anxiety and readmissions in service users discharged from an inpatient…
Abstract
Purpose
The purpose of this study is to assess if the new community-enhanced rehabilitation team reduced anxiety and readmissions in service users discharged from an inpatient rehabilitation setting.
Design/methodology/approach
The study used both qualitative and quantitative methodology. Service user’s anxiety level was measured before being discharged and at the end of the Community Enhanced Rehabilitation Team (CERT) transition intervention. Six service users were interviewed to gain further understanding of their experiences of anxiety.
Findings
Findings showed the anxiety score was significantly lower (M = 1.5, 95% CI [0.051,2.99], t(20) = 2.159, p = 0.043) following the CERT intervention (M = 8.6, SD = 6.4) compared to before (M = 10.1, SD = 7.0). No service user receiving the CERT intervention was readmitted to hospital within 12 weeks of discharge from the inpatient setting, compared to three service users (15% of those discharged) who were discharged to other community services.
Research limitations/implications
Community rehabilitation pathways would benefit from having interventions to aid patient transitions from inpatient to the community. The National Health Service (NHS) trusts develop community rehabilitation teams as recommended by the National Institute for Health and Care Excellence (NICE), and they should consider including transitional support as part of their model.
Practical implications
It is recommended that as NHS trusts design and implement community mental health teams, they should consider including transition support as part of their model.
Social implications
People with severe and enduring mental health difficulties who have been in an inpatient rehabilitation setting would benefit from community transitional support. This study suggests that such support helps reduce anxiety and readmission.
Originality/value
Community rehabilitation teams are currently being developed across the NHS as part of the NHS long-term plan. These teams are new, and as such, there is a dearth of information regarding their effectiveness. To the best of the authors’ knowledge, this is one of the first studies to evaluate outcomes in these new teams.
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Kristy Buccieri, Abram Oudshoorn, Tyler Frederick, Rebecca Schiff, Alex Abramovich, Stephen Gaetz and Cheryl Forchuk
People experiencing homelessness are high-users of hospital care in Canada. To better understand the scope of the issue, and how these patients are discharged from hospital, a…
Abstract
Purpose
People experiencing homelessness are high-users of hospital care in Canada. To better understand the scope of the issue, and how these patients are discharged from hospital, a national survey of key stakeholders was conducted in 2017. The paper aims to discuss this issue.
Design/methodology/approach
The Canadian Observatory on Homelessness distributed an online survey to their network of members through e-mail and social media. A sample of 660 stakeholders completed the mixed-methods survey, including those in health care, non-profit, government, law enforcement and academia.
Findings
Results indicate that hospitals and homelessness sector agencies often struggle to coordinate care. The result is that these patients are usually discharged to the streets or shelters and not into housing or housing with supports. The health care and homelessness sectors in Canada are currently structured in a way that hinders collaborative transfers of patient care. The three primary and inter-related gaps raised by survey participants were: communication, privacy and systems pressures.
Research limitations/implications
The findings are limited to those who voluntarily completed the survey and may indicate self-selection bias. Results are limited to professional stakeholders and do not reflect patient views.
Practical implications
Identifying systems gaps from the perspective of those who work within health care and homelessness sectors is important for supporting system reforms.
Originality/value
This survey was the first to collect nationwide stakeholder data on homelessness and hospital discharge in Canada. The findings help inform policy recommendations for more effective systems alignment within Canada and internationally.
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