Development of Nursing Practice Guidelines for Discharge Planning and Continuity of Care in Patients with Lower Cervical Spine and Spinal Cord Injuries at Khon Kaen Hospital

การวิจัยเชิงปฏิบัติการโดยใช้รูปแบบ PAOR กรณีศึกษาโรงพยาบาลขอนแก่น การพัฒนาผลลัพธ์หลังจำหน่ายโดยความร่วมมือของทีมสหสาขาวิชาชีพ การเสริมสร้างการดูแลต่อเนื่องในระยะเปลี่ยนผ่านสำหรับผู้ป่วยบาดเจ็บไขสันหลัง

Abstract

Development of Nursing Practice Guidelines for Discharge Planning and Continuity of Care in Patients with Lower Cervical Spine and Spinal Cord Injuries at Khon Kaen Hospital

Suthida Saensung

Discharge planning and continuity of care for patients with lower cervical spine and spinal cord injuries is a complex process due to the high incidence of permanent disabilities, such as hemiplegia or quadriplegia, which often require prolonged and costly hospitalizations and can result in chronic illness or death. In 2018, data from the spinal unit at Khon Kaen Hospital showed that 16 patients classified under Intermediate Care had a maximum length of stay of 217 days, incurring treatment costs up to 1,377,603 THB. Key performance indicators during that year were suboptimal, with a patient satisfaction rate of 87.62%, a 28-day readmission rate of 18.5%, and an average length of hospital stay of 82.57 days. Contributing factors included the complexity of the disease and the absence of a standardized nursing discharge planning and follow-up care protocol. Healthcare personnel lacked confidence in discharge planning, and community hospitals were often unequipped or unprepared to care for spinal cord injury patients.

This study aimed to develop and implement nursing practice guidelines for discharge planning and continuity of care for patients with lower cervical spine and spinal cord injuries. The participants included 15 professional nurses and 30 patients. The PAOR (Plan–Act–Observe–Reflect) action research model by Kemmis and McTaggart was applied. The planning phase included a situational analysis of 20 medical records of patients hospitalized for more than 28 days. The action phase consisted of: 1) guideline development, 2) use of Intermediate Care assessment tools (ADL scores, motor power assessments), 3) creation of patient self-care manuals, and 4) organization of hands-on training workshops. During the observation phase, the guidelines were implemented from 2019 to 2021, with continuous monitoring. In the reflection phase, evaluation of the first implementation cycle showed improved indicators: satisfaction rates increased to 90.09%, 97.51%, and 99.59 respectively; 28-day readmission rates decreased to 6.6%, 6.25%, and 11.11%; and the average hospital stay dropped to 28, 27.78, and 27.78 days.

However, areas for improvement were identified, such as inconsistent family genogram documentation, unclear criteria for transitioning to the rehabilitation phase, lack of home-use medical equipment, and delays in coordination with network hospitals. A second PAOR cycle in 2022 addressed these issues with the following actions: 1) standardization of family genogram documentation, 2) defined transition criteria to rehabilitation within 48 hours of stable vital signs, 3) creation of communication and equipment requisition channels via LINE, and 4) early coordination with network hospitals and joint quality rounds with multidisciplinary teams. The second evaluation showed improved outcomes with a satisfaction rate of 99.54%, a 28-day readmission rate of 5%, and a reduced average hospital stay of 12.90 days. These findings highlight the ongoing challenges and the need for further data analysis to identify factors contributing to post-discharge readmissions for future impro