Case Study: Discharge Dilemma: Managing Disagreements
Jack Flynn is a 60-year-old construction worker who had a total knee replacement 2 days ago. At this point, decisions about discharge from the hospital are being made. The surgeon recommends discharge to home with an exercise program provided by an application available on the computer or phone, without any other services until after the 6-week postoperative visit. The occupational therapist (OT) recommends discharge to home with immediate follow up by a home care nurse and OT via home therapy services. The physical therapist recommends discharge with a short stay in a subacute rehabilitation facility. The nurse acknowledges that the patient and family can carry out incision care at home but would prefer one to two visits by a home care nurse to follow up with any questions or potential complications. Mr. Flynn and his family are worried about his ability to negotiate stairs when entering the home and regaining full motion in the knee considering the pain and swelling. Mr. Flynn says he does not like computer technology and prefers face-to-face care.
Discussion Questions
- How can the team engage in shared patient-centered problem solving related to Mr. Flynn’s discharge?
- Provide at least three examples of decision-making strategies to plan for discharge and recovery. Refer to Chapters 13 and 14.
- How can available evidence be used to guide effective team decision making in this case study?
Addressing the discharge dilemma for Mr. Flynn involves careful consideration and collaboration among the healthcare team to ensure his needs are met while aligning with his preferences. Let’s delve into the questions:
- Engaging in Shared Patient-Centered Problem Solving:
- Patient Preference: Start by understanding Mr. Flynn’s concerns and preferences. A team meeting involving Mr. Flynn, his family, and all healthcare professionals can facilitate an open discussion about his concerns, needs, and goals.
- Assessment: Conduct a comprehensive assessment of Mr. Flynn’s physical condition, pain level, mobility, home environment, and support system to identify potential challenges and needs.
- Collaborative Decision-Making: Use a collaborative approach where each healthcare professional presents their recommendations and rationale. Then, discuss and weigh the pros and cons of each option together with Mr. Flynn and his family.
- Decision-Making Strategies for Discharge and Recovery:
- Shared Decision-Making Model: Utilize a shared decision-making model where Mr. Flynn, his family, and healthcare professionals collectively decide on the discharge plan that best fits his needs and preferences.
- Risk-Benefit Analysis: Perform a risk-benefit analysis for each discharge option considering Mr. Flynn’s condition, preferences, and potential outcomes, weighing the risks and benefits of home care, subacute rehabilitation, and outpatient therapy.
- Gradual Transition: Consider a phased approach. Initiate care at home with close monitoring and follow-up, gradually transitioning to more intensive rehabilitation if needed based on his progress.
- Using Available Evidence for Effective Decision Making:
- Evidence-Based Practices: Utilize evidence-based guidelines and research findings on post-knee replacement rehabilitation outcomes to guide decision-making. Look into studies comparing outcomes of home-based therapy, subacute rehabilitation, and outpatient care for knee replacement patients.
- Patient Outcomes Data: Review past patient outcomes in similar scenarios to assess the success rates and complications associated with various discharge options.
- Consultation with Experts: Seek input from experts in orthopedic rehabilitation and post-surgery care to gain insights and recommendations based on their experiences and expertise.
By combining patient preferences, evidence-based practices, and collaborative decision-making, the healthcare team can craft a discharge plan that aligns with Mr. Flynn’s needs while ensuring the best possible outcomes for his recovery after knee replacement surgery.