Discharge readiness as an infrastructure: Negotiating the transfer of care for elderly patients in medical wards

Abstract

The discharge from hospital is an essential care transition for elderly people with chronic illness, specifically because the responsibility for treatment and care is transferred between locations and healthcare staff. To optimise the use of healthcare resources in a time of progressively shorter hospital admissions and increasingly streamlined hospital care, discharges are highlighted as important moments to be handled with caution. Yet, discharges are expected to be "early" and "quick" procedures to maintain a flow of patients through the hospital. In this qualitative article, we use ethnographic methods to investigate how this apparent contradiction unfolds in everyday discharge situations through the work of establishing discharge readiness in three medical wards in a middle-sized Danish hospital. We use the lens of infrastructure to help us see how elements like patient screens, screen meetings, clinical (and embodied) signs and community health care criteria are interrelated in the work of establishing discharge readiness of patients. By looking closely into specific discharge situations, we analyse the way care needs are defined and how care work is transferred, and we identify the inherent uncertainties for health care professionals, patients and relatives. We show how clinical signs take precedence over embodied experience, and how complex situations are reduced to workable problems to enable discharge.

Keywords: Chronic illness; Denmark; Discharge readiness; Ethnography; Hospital discharge; Hospital ethnography; Infrastructure; Medical ward; Transitional care.