Discharge (Discontinuation) Planning

OT Dude Academy’s Free NBCOT® Exam Prep Course Process Discharge (Discontinuation) Planning
Update

Discharge now considers transition and discontinuation in the terminology. Includes transition in services, e.g., one setting or program to another. Collaboration is highly important to ensure the safety and well-being of the client and for optimal outcomes. May occur within or outside the OT discipline. Also involves groups and populations. 1 

Discharge Team Involvement2 

  • Solo/Single-practitioner
  • Case manager
  • Part of an interdisciplinary, transdisciplinary, or multidisciplinary team (See Types of Teams Lesson)

Discharge Planning Process

  • Begins upon admission.3 
  • May occur when the client chooses to discontinue receiving services.4 
  • Utilize any pertinent information such as the occupational profile, performance status, personal priorities, values, perspectives, issues, and difficulties in the planning process.5 
  • Coordinate between/with the team members (if applicable).
  • Provide multiple choices if possible.5 
  • Assess for the level of independence versus assistance needed for occupations and any necessary equipment or services.5 
  • Use specific tools, e.g., baseline grip strength, as predictors of future occupational assistance, compensatory strategies, equipment, or safety considerations.6 
  • Create an accurate clinical picture and assess if the goals are realistic and ideal for discharge.5 
  • Use critical and reasoning skills and consider the client’s needs for discharge.7 
  • Integrate a client- or family-centered approach to the discharge decision-making.8 9 
  • Acknowledge the client or family’s wishes for discharge.5 
  • Inform client and family of the potential risks associated with a less optimal discharge plan.5 
  • Coordinate safe, efficient, and timely discharge.10 11 
  • Emphasize the client’s current level of cognitive functioning and clarify their level of deficit awareness.5 
  • Assess for high perceived risk with regard to safety.12 13 
  • Evaluate if the outcomes of interventions help clients function better in their daily life for post-discharge in regards to their own skills and abilities.14 
  • Identify factors that impact the client’s discharge or readmission such as social problems, finance, daily routines, and social relations.15 
  • Include clear discharge goals for clients.16 
  • Recommend discharge destination, equipment needs, and follow-up services.17 18 
  • Complete home assessments if appropriate.19 
  • Conduct community visits to assist in integration back into the community if appropriate.3 
  • Advise on any appropriate services, resources, environments, and needs for the client at discharge, including further occupational therapy services.3 
  • Provide family and caregiver education, support, and training.20 21 
  • Identify psychosocial risk factors of clients, parents, and caregivers.22 
  • (Mental Health) Continue individual or group training after discharge in the community or home environment.23 
  • Meet best practice standards.24 

Factors Affecting Discharge Planning

  • There is a growing emphasis on reducing the length of stay.25 26 
  • Assist in reducing unnecessary hospital readmission.26 
  • Linked with a cost minimization model for medical care in the US.27 
  1. American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001[↩]
  2. Moyers, P. A. (1999). The guide to occupational therapy practice. American Journal of Occupational Therapy, 53(3), 247-322.[↩]
  3. Duffy R, Nolan P (2005) A survey of the work of occupational therapists in inpatient mental health services. Mental Health Practice 8(6): 36–41[↩][↩][↩]
  4. American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001[↩]
  5. Holm, S. E., & Mu, K. (2012). Discharge planning for the elderly in acute care: the perceptions of experienced occupational therapists. Physical & Occupational Therapy In Geriatrics, 30(3), 214-228.[↩][↩][↩][↩][↩][↩][↩]
  6. Huang, W.W., Perera, S., VanSwearingen, J. & Studenski, S. (2010). Performance measures predict the onset of activity of daily living difficulty in community-dwelling older adults. Journal of the American Geriatric Society, 58, 844–852.[↩]
  7. Mitchell, R. & Unsworth, C. (2005). Clinical reasoning during community health home visits: expert and novice differences. British Journal of Occupational Therapy, 68, 215–223.[↩]
  8. Moats, G. (2006). Discharge decision-making with older people: The influence of the institutional environment. Australian Occupational Therapy Journal, 53, 107–116.[↩]
  9. Moats, G. (2007). Discharge decision-making, enabling occupations, and client-centered practice. Canadian Journal of Occupational Therapy, 74, 91–101.[↩]
  10. Holm, S. E. (2012). Discharge planning for the elderly in acute care: The perceptions of experienced occupational
    therapists. Physical & Occupational Therapy in Geriatrics, 30, 214–228. doi: http://dx.doi.org.dbgw.lis.curtin.edu.au/10.3109/02703181.2012.719601[↩]
  11. Roberts, P. S. & Robinson, M. R. (2014). Occupational therapy’s role in preventing acute readmissions. American Journal of Occupational Therapy, 68, 254–259. doi: 10.5014/ajot.2014.683001[↩]
  12. Atwal, A., Wiggett, C. & McIntyre, A. (2011). Risks with older adults in acute care settings: Occupational therapists’ and physiotherapists’ perceptions. British Journal of Occupational Therapy, 74, 412–418. doi: http://dx.doi.org.dbgw.lis.curtin.edu.au/10.4276/030802211X13153015305510[↩]
  13. Atwal, A., McIntyre, A. & Wiggett, C. (2012). Risks with older adults in acute care settings: UK occupational therapists’ and physiotherapists’ perceptions of risks associated with discharge and professional practice. Scandinavian Journal of Caring Sciences, 26 (2), 381–393. doi:http://dx.doi.org.dbgw.lis.curtin.edu.au/10.1111/j.1471-6712.2011.00946.x[↩]
  14. Lim K, Morris J, Craik C (2007) Inpatients’ perspectives of occupational therapy in acute mental health. Australian Occupational Therapy Journal. 54(1): 22–32[↩]
  15. Eaton P (2002) Psychoeducation in acute mental health settings: Is there a role for occupational therapists. Br J Occup Ther 65(7): 321–6[↩]
  16. Griffin, S. D. & McConnell, D. (2001). Australian occupational therapy practice in acute care settings. Occupational
    Therapy International, 8, 184–197.[↩]
  17. Crennan, M. & MacRae, A. (2010). Occupational therapy discharge assessment of elderly patients from acute care hospitals. Physical & Occupational Therapy in Geriatrics, 28, 33–43. doi: 10.3109/02703180903381060[↩]
  18. Jette, D.U., Grover, L. & Keck, C.K. (2003). A qualitative study of clinical decision-making in recommending discharge placement from the acute care setting. Physical Therapy, 83, 224–236.[↩]
  19. Welch, A. & Lowes, S. (2005). Home assessment visits within the acute setting: A discussion and literature review. British Journal of Occupational Therapy, 68, 158–164.[↩]
  20. Popejoy, L.L. (2011a). Complexity of family caregiving and discharge planning. Journal of Family Nursing, 17, 61–81. doi: 10.1177/1074840710394855[↩]
  21. Preyde, M., Macaulay, C. & Dingwall, T. (2009). Discharge planning from hospital to home for
    elderly patients: A meta-analysis. Journal of Evidence-Based Social Work, 6, 198–216. doi:10.1080/15433710802686898[↩]
  22. Domanski, M. D., Jackson, A. C., Miller, J., & Jeffrey, C. (2003). Towards the development of a paediatric discharge planning screening tool. Journal of Child Health Care, 7(3), 163-183.[↩]
  23. Lloyd, C., & Lee Williams, P. (2010). Occupational therapy in the modern adult acute mental health setting: A review of current practice. International Journal of Therapy and Rehabilitation, 17(9), 483-493.[↩]
  24. Wolock, I. and Schlesinger, E.G. (1986) ‘Social Work Screening in New Jersey Hospitals: Progress, Problems and Implications’, Health and Social Work 11(1): 15–24[↩]
  25. Blaga, L. & Robertson, L. (2008). The nature of occupational therapy practice in acute physical care settings. New Zealand Journal of Occupational Therapy, 55 (2), 11–18.[↩]
  26. Carlill, G., Gash, E. & Hawkins, G. (2002). Preventing unnecessary hospital admissions: An occupational therapy and social work service in an accident and emergency department. British Journal of Occupational Therapy, 65, 440–445.[↩][↩]
  27. Crennan, M. & MacRae, A. (2010). Occupational therapy discharge assessment of elderly patients from acute care hospitals. Physical & Occupational Therapy in Geriatrics, 28
    (1), 33–43. doi: http://dx.doi.org.dbgw.lis.curtin.edu.au/10.3109/02703180903381060[↩]
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