Promoting the Inclusion of Care Partners of People Living With Dementia in Hospital Care Through Workflow Redesign

Care partners frequently report feeling unprepared to fulfill caregiving tasks when their family member or friend living with dementia returns home from the hospital (Bauer et al., 2011; Schulz et al., 2018).This lack of preparedness may be explained by insufficient hospital workflows to guide occupational therapy (OT) practitioners when identifying, assessing, and educating care partners. This descriptive exploratory study identified strengths and challenges of hospital-based dementia care to redesign current workflows that better include care partners. Applying an evidence-supported, systems engineering approach (Holden et al., 2013), we completed a total of 27 hours of direct observation in a large academic hospital, 11 qualitative fieldnotes, and three interdisciplinary team debriefing meetings. Strengths and challenges were identified by completing a framework method for analysis (Gale et al., 2013) in NVivo software. Strengths include practitioners’ willingness and ability to answer care partners’ questions, care partner advocacy skills, and the availability of electronic health record drop-down fields focused on patient/family education. Challenges include inconsistent documentation practices, under-utilization of hospital common spaces, and practitioners’ only passively including care partners. Using process mapping in Lucidchart software, we mapped these strengths and challenges onto three hospital workflows. One workflow outlines steps to help practitioners identify and assess care partners for their preferences and needs during the patient’s admission. Another workflow outlines steps to help practitioners maintain contact with the care partner during the patient’s hospital stay. The last workflow outlines steps to help practitioners prepare care partners for the patient’s hospital discharge. Future research should investigate the effectiveness of these workflows in guiding OT practitioners and ultimately increasing preparedness of dementia care partners.

References

Bauer, M., Fitzgerald, L., Koch, S., & King, S. (2011a). How family carers view hospital discharge planning for the older person with a dementia. Dementia, 10(3), 317–323. https://doi.org/10.1177/1471301211407790

Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13(1). https://doi.org/10.1186/1471-2288-13-117

Holden, R. J., Carayon, P., Gurses, A. P., Hoonakker, P., Hundt, A. S., Ozok, A. A., & Rivera-Rodriguez, A. J. (2013). SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56(11), 1669–1686. https://doi.org/10.1080/00140139.2013.838643

Schulz, R., Beach, S. R., Friedman, E. M., Martsolf, G. R., Rodakowski, J., & James, A. E. (2018). Changing structures and processes to support family caregivers of seriously ill patients. Journal of Palliative Medicine, 21(S2). https://doi.org/10.1089/jpm.2017.0437