An assessment of discharge planning models: communication in referrals for home care

A home care referral generated upon hospital discharge communicates essential patient care information, links service providers, and facilitates continuity of patient care. The literature however, reveals that communication efforts are often inadequate and may even fail in this system. The purpose of this research was to examine whether various discharge planning models employed by hospitals resulted in differences in the quantity and quality of communication about patients referred for home health care. Kelly and McClelland's (1985) typology of discharge planning models provided the framework for the study. Using instruments designed specifically for this project, six referring hospitals' functional discharge planning models were labeled and 300 closed home care records of referrals were reviewed to ascertain the amount and type of data transmitted. Results indicated that only slightly more than half of the data recommended by the literature was actually transferred and that data was primarily background in nature. The hospital discharge planning model did make a significant difference in the amount and type of data shared, with liaison nurses sending the greatest amount of data. However, both conceptually and in practice, the discharge planning models simply describe an allocation of responsibility among various health personnel. They are not operational models in the traditional sense.