Identification of Issues Contributing to Longer Length of Stay and Higher Readmission Rates for Parkinson's Patients Admitted to Hospital

BACKGROUND: People with Parkinson's disease (PD) are a vulnerable cohort of people, more likely to suffer serious health-related problems when admitted to hospital. Literature suggests that health service improvement utilising a robust health care redesign framework, can improve local service delivery and outcomes for hospitalised PD patients. AIM/OBJECTIVES: This healthcare redesign project aims to identify the issues that contribute to PD patients experiencing a longer length of stay (LOS) and (re)admitting to a tertiary hospital in Sydney, Australia. Quantitative analysis of hospital data previously identified comorbidities present on admission that impact LOS and acquired complications that significantly extend LOS. This paper demonstrates the benefits of utilising mixed methods to provide a comprehensive picture of the PD patient's inpatient experience. METHODS: Mixed-methods healthcare redesign diagnostic tools were used to gather evidence and understand the issues. RESULTS: Seventy-eight percent (n = 831) of PD patients admitted to the emergency department were triage category 1, 2 or 3. 58.5% of PD patients have their PD medications charted within 4 h of admission. Their average LOS was 13 days. Data triangulation identified several barriers to optimal care, with prioritisation activities identifying three high-impact, feasible targets for improvement: PD medication management during nil-by-mouth periods, timely medication charting and timely discharge planning. Root causes (lack of formalised care pathways, limited access to resources and poor coordination of PD services) were identified as contributing to PD patients experiencing a longer LOS and higher readmission rates. Poor communication between clinicians within the hospital, fragmented transitions between hospital and community services and limited access to specialist resources were identified as key system-level barriers requiring prioritisation in the subsequent redesign phase. CONCLUSIONS: The use of mixed methods provided a rich understanding of the PD patient experience of a hospital admission and prolonged length of stay. This study identified system-level barriers to optimal Parkinson's disease care, providing clear targets for service redesign to improve patient outcomes and hospital efficiency. Addressing gaps in Parkinson's disease medication management, discharge planning and interdisciplinary communication may improve inpatient outcomes, reduce avoidable complications and decrease hospital length of stay and readmissions. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a critical role in advocating for and leading improvements in the quality, safety and efficiency of care for PD patients. This subsequently improves the PD patient's hospital experience. Nursing practice should focus on prioritising accurate and timely medication management, strengthening communication between clinicians to expedite discharge planning and advocating for PD-specific knowledge and education to improve patient outcomes, reduce length of stay and service efficiencies. PATIENT AND PUBLIC CONTRIBUTION: Patients and members of the public were not involved in the design, conduct, analysis, reporting or dissemination of this healthcare redesign project.