Development of a Follow-up Model to Prevent Post-Discharge Infections in Changhan Hospital

Abstract

Purposes: To examine the current situation problems and needs related to post-discharge follow-up and infection prevention at Changhan Hospital. To develop and implement a follow-up model and evaluate outcomes in terms of post-discharge infections and satisfaction among the stakeholders involved.

Study design: Research and development using mixed methods.

Materials and Methods: The research was conducted in four phases including situation analysis model development implementation and evaluation. Participants were selected using purposive sampling and included 15 healthcare professionals and 43 patients with 43 primary caregivers. Instruments comprised interview and focus group guides a risk assessment form a follow-up record and a satisfaction questionnaire with a reliability coefficient of 0.89. Patients were followed for 30 days after discharge. Outcomes were compared with pre-development data from retrospective medical records. Data were analyzed using descriptive statistics and content analysis.

Main findings: The existing service lacked standardized screening, follow-up, practical caregiver training, and timely referrals, while caregivers needed skill training and consultation channels. The developed model comprised risk classification caregiver preparation remote follow-up and coordination between primary care networks and emergency response systems. After implementation infections occurred in 2.33% of patients compared with 18.60% before implementation. Infection-related readmissions occurred in 2.33% compared with 13.95% before implementation. Mean satisfaction scores (Mean ± SD) among healthcare professionals patients and primary caregivers were 4.62 ± 0.41, 4.68 ± 0.38, and 4.74 ± 0.35, respectively, all at the highest level.

Conclusion and recommendations: Lower proportions of infections and infection-related readmissions were observed after model implementation alongside the highest level of stakeholder satisfaction. The model may be applied to support continuity of care. Further research using a comparison group is recommended to confirm the effectiveness of the developed follow-up model.