Hospital discharge of adults and older adults: checklist elaboration and validity

Gheno, Jociele; Lombardini, Amanda Aires; Araújo, Kellen Cristina; Weis, Alisia Helena

doi:10.37689/acta-ape/2024AO0022911

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Original Article • Acta Paul Enferm 37 • 2024 • https://doi.org/10.37689/acta-ape/2024AO0022911 copy

Hospital discharge of adults and older adults: checklist elaboration and validity

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To describe content elaboration and validity of a checklist for preparing adults and older adults for hospital discharge.

Methods

This is a methodological study, developed from May 2020 to September 2022 (in two stages), for checklist elaboration and validity. The Delphi technique was used, with assessment by an expert committee for content validity. To calculate the degree of agreement, the agreement rate and the Content Validity Index (CVI) were used.

Results

A checklist with 17 items that help organize hospital discharge was prepared and validated. The checklist was prepared based on the compilation of results obtained from interviews with multidisciplinary team professionals, who worked in inpatient units, an integrative review on transition of care at hospital discharge of adult patients and reading of articles on the use of discharge checklist. In the first stage of validity, a mean was obtained for the instrument’s agreement rate, scope (94%) and relevance (91%). At the end of the second round, the mean CVI calculation was obtained (clarity: 0.95; relevance: 0.96).

Conclusion

The checklist was validated as to its content by consensus by an expert committee, and can be used by care teams or hospital discharge management.

Checklist; Transicional care; Continuity of patient care; Patient discharge

Professional categories	1^st round n(%)	2^nd round n(%)
Physician	4(33)	1(10)
Nurse	3(25)	5(50)
Social worker	2(17)	2(20)
Pharmaceutical	1(8)	1(10)
Physical therapist	2(17)	1(10)
Time passed after graduation (year)
1-5	1(8,3)	0(0)
6-10	4(33,3)	3(30)
11-15	2(17)	3(30)
16-20	1(8)	1(10)
> 20	4(33,3)	3(30)
Training levels
Specialization	4(33,3)	3(30)
Master’s degree	4(33,3)	3(30)
Doctorate degree	3(25)	3(30)
Postdoctoral degree	1(8,3)	1(10)
Performance field
Hospital admission	7	4
Health Services Management	5	6
Primary Health Care	2	0
Home Care Service	5	2
Permanent education/professor/preceptor	3	2
Researcher	2	3
Time working with transition of care activities (years)
1-5	2(17)	3(30)
6-10	7(58)	5(50)
11-15	3(25)	2(20)
Publications on transition of care
Yes	5(42)	4(40)
No	7(58)	6(60)

Items assessed for	Sco (%)	Rel (%)	Suggestions
Title: “CHECKLIST FOR QUALIFIED DISCHARGE”	83	83	Specify that discharge is “hospital discharge”
Checklist initial guidelines	83	92	Improve the wording and clarify that the checklist can be completed during hospitalization.
IDENTIFICATION	83	92	Swap bed number for ID.
SOCIAL SUPPORT	100	100	Replace “family car” with “own transport” and add the item “other”; add caregiver’s age; confirm that patient has a link with the health unit.
CARE/GUIDELINES FOR PATIENTS AND FAMILIES ABOUT
USE OF OXYGEN (O2) AT HOME	100	83	No suggestion
TRACHEOSTOMY (TCT)	100	92	Add if patient has a TCT withdrawal plan after discharge.
NUTRITION/DIET	92	92	Delete “TPN” and replace “state” with “RS State Department of Health”.
DIALYSIS	100	92	Replace “family car” with “own transport” and add the item “other”; change that the social worker “guided” the flow of transport request for hemodialysis.
URINARY ELIMINATIONS	100	100	Make the text more succinct.
INTESTINAL ELIMINATIONS	100	100	No suggestion
DRESSINGS	100	100	Add the item “whether you have been instructed on where to pick up materials for dressing”.
MEDICATIONS	92	92	In the guidelines on use: replace “morphine” with “opioids” and add “antimicrobial”. Add guidelines on route, dosage and acquisition of special medications.
DEGREES OF PATIENT DEPENDENCY	92	75	Replace the Katz table with more succinct items.
FINAL GUIDELINES	92	83	Add the items about referrals made by the social worker, “participation in smoking groups”, “tuberculosis treatment”, “signs and symptoms of infections” and the item asking if patient has doubts about the given guidelines.
POST-DISCHARGE REFERRALS TO
PRIMARY HEALTH CARE (PHC)	83	92	Add item on “patient supervision” due to its low compliance with treatment.
HOME CARE SERVICE (HCS)	100	92	Modify the wording of item “HCS team contacted the assisting medical team”.
OUTPATIENT	100	100	No suggestion
GUIDELINES FOR HEALTH NETWORK PROFESSIONALS	83	83	Combine the first two items, as they speak of social support for patient; replace “morphine” with “opioids” and add “antimicrobial”; add the item on “referral of transport for hemodialysis”.
Mean agreement rate	94	91

Checklist items assessed for:	Clarity	Relevance
Title change: ‘‘CHECKLIST FOR HOSPITAL DISCHARGE’’	1.00	1.00
Initial guidelines	0.90	1.00
IDENTIFICATION	1.00	1.00
SOCIAL SUPPORT	1.00	1.00
CARE/GUIDELINES FOR PATIENTS AND FAMILIES ABOUT
USE OF OXYGEN (O2) AT HOME	1.00	1.00
TRACHEOSTOMY	1.00	1.00
NUTRITION/DIET	1.00	1.00
DIALYSIS	1.00	1.00
URINARY ELIMINATIONS	1.00	1.00
INTESTINAL ELIMINATIONS	0.90	0.90
DRESSINGS	1.00	0.90
MEDICATIONS	0.90	0.90
LEVEL OF DEPENDENCY	0.80	0.90
OTHER GUIDELINES	0.90	0.90
POST-DISCHARGE REFERRALS
PRIMARY HEALTH CARE (PHC)	1.00	0.90
HOME CARE SERVICE (HCS)	0.90	1.00
OUTPATIENT	0.90	0.90
GUIDELINES FOR HEALTH NETWORK PROFESSIONALS	0.90	0.90
CVI calculation means	0.95	0.96

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Jociele Gheno Email: pita.gheno@hotmail.com