| Description |
The purposes of this study were: (a) to implement a discharge screening program for low and high risk patients on the internal medicine service; (b) to determine whether or not a selected group of patients identified as low risk or high risk were appropriately classified by evaluation their functional capacity in activities of daily living and their need for services; and (c) to evaluate the effectiveness of the discharge screening program for the low and high risk patients. The population studied consisted of all direct admissions to the internal medicine service at the University of Utah Medical Center for 1 month. Data for the study were collected through the use of two instruments. The Record Review Schedule contained the high risk criteria which, if any single indicator was present, flagged the patient as high risk and required a social work assessment. The second instrument was the OARS Multidimensional Functional Assessment Questionnaire modified for this study by using the functional assessment in "Activities of Daily Living" and the "Utilization of Services" in Part B with additional questions from Part A. The results obtained from the OARS questionnaire were used in comparison with each patients' rating on the Record Review Schedule. This comparison provided a basis for evaluating the high risk indicators. The findings of this study revealed that 78% of the patients were classified as high risk. Of the high risk 46% were referred to social work. Of the 44 patients who had an activities of daily living (ADL) score of 4 or greater (moderately impaired to completely impaired) 95.5% were classified as high risk. The ADL score, when compared with low/high risk, was significant at the p < .05 level. The ADL score was also significant when compared with the need for supportive and remedial services, especially the need for supervision, homemaker, nursing care, and coordination/information/referral service (CIRS). Recommendations include the modification and revision of current indicators, development of a screening tool shared by nursing and social work, development of a training program for admitting personnel, and a multidisciplinary approach using discharge planning teams. |
