ANALYSIS OF THE RELATIONSHIP BETWEEN DISCHARGE PLANNING DOCUMENTATION COMPLIANCE AND LENGTH OF STAY AND READMISSION IN STROKE AND HEAD INJURY PATIENTS AT AWAL BROS PEKANBARU HOSPITAL
DOI:
https://doi.org/10.54973/jham.v7i1.936Keywords:
discharge planning, LOS, readmission, stroke, head injuryAbstract
Stroke and traumatic brain injury are commonly associated with prolonged hospital stay and readmission. Effective discharge planning is essential to ensure continuity of care; however, documentation compliance remains suboptimal. The objective of this research is to examine the association between discharge planning documentation compliance based on the METHOD and IDEAL models and length of hospital stay and 30-day readmission among stroke and traumatic brain injury patients. A quantitative analytical observational study with a retrospective cross-sectional design was conducted using medical records of 111 stroke and traumatic brain injury patients admitted to Awal Bros Hospital Pekanbaru between October and December 2025. Data were analyzed using Spearman's correlation, Mann–Whitney U, Kruskal–Wallis, multiple linear regression, and logistic regression. Source triangulation through confirmatory interviews with healthcare professionals was performed to validate discharge planning implementation. Poor discharge planning documentation was identified in 51.4% of the METHOD model and 44.1% of the IDEAL model. The IDEAL score showed a weak positive association with length of hospital stay (r=0.194; p=0.042), whereas the METHOD score was not significant. Neither model was associated with 30-day readmission (p>0.05). Comorbidity and complete functional dependence were significant predictors of prolonged hospitalization. Source triangulation confirmed that discharge planning was routinely implemented, although documentation remained incomplete, particularly in patient education, medication management, and dietary counseling. Discharge planning documentation showed a weak association with length of hospital stay but not with 30-day readmission. Strengthening documentation quality and multidisciplinary coordination is essential to improve continuity of care.
Downloads
References
Ahlbom, A. (2021). Modern Epidemiology, 4th edition. TL Lash, TJ VanderWeele, S Haneuse, KJ Rothman. Wolters Kluwer, 2021. European Journal of Epidemiology, 36(8), 767–768. https://doi.org/10.1007/s10654-021-00778-w
AHRQ. (2017). Strategy 4: Care Transitions From Hospital to Home: IDEAL Discharge Planning. Agency for Healthcare Research and Quality. https://www.ahrq.gov/patient-safety/patients-families/engagingfamilies/strategy4/index.html
Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W.-J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. Annals of Family Medicine, 15(5), 419–426. https://doi.org/10.1370/afm.2121
Asriyati, P. E., Swarjana, I. K., Sastriani, N. L. A., & Krisnandari, A. A. I. W. (2021). The Effect of Electronic Discharge Planning with SBAR Approach to Optimize the Implementation of Patient Discharge. International Journal of Health and Medical Sciences, 4(3), 280–287. https://doi.org/10.31295/ijhms.v4n3.1750
Campbell, B. C. V., & Khatri, P. (2020). Stroke. The Lancet, 396(10244), 129–142. https://doi.org/10.1016/S0140-6736(20)31179-X
Coleman, E. A., Parry, C., Chalmers, S., & Min, S. (2006). The Care Transitions Intervention: Results of a Randomized Controlled Trial. Archives of Internal Medicine, 166(17), 1822–1828. https://doi.org/10.1001/archinte.166.17.1822
de Berker, H., de Berker, A., Aung, H., Duarte, P., Mohammed, S., Shetty, H., & Hughes, T. (2021). Pre-stroke disability and stroke severity as predictors of discharge destination from an acute stroke ward. Clinical Medicine, 21(2), E186–E191. Health & Medical Collection (2561108722). https://doi.org/10.7861/clinmed.2020-0834
Direktorat Jenderal Pelayanan Kesehatan. (2024). Keputusan Direktur Jenderal Pelayanan Kesehatan Nomor HK.02.02/D/47104/2024 tentang Instrumen Survei Akreditasi Rumah Sakit (HK.02.02/D/47104/2024). Kementerian Kesehatan Republik Indonesia.
Donabedian, A. (2003). An Introduction to Quality Assurance in Health Care. Oxford University Press.
Gonçalves-Bradley, D. C., Lannin, N. A., Clemson, L., Cameron, I. D., & Shepperd, S. (2022). Discharge planning from hospital. Cochrane Database of Systematic Reviews, 2022(2). Scopus. https://doi.org/10.1002/14651858.CD000313.pub6
Gupta, A., Brazier, B., Rengarajan, L., Narendran, P., & Kempegowda, P. (2024). Determining factors influencing hospital stay for individuals admitted with diabetes-related ketoacidosis -findings from DEKODE length of stay quality improvement project. Clinical Medicine, 24(6), 1–6. Health & Medical Collection (3165158054). https://doi.org/10.1016/j.clinme.2024.100255
Jannah, N., Sukartini, T., & Hidayat, A. A. A. (2019). Discharge Planning Model with Approach of Method in Improving Patients’ Readiness for Discharge in Hospitals. Indian Journal of Public Health Research & Development, 10(1), 288–292.
Jencks, S. F., Williams, M. V., & Coleman, E. A. (2009). Rehospitalizations among patients in the medicare fee-for-service program. New England Journal of Medicine, 360(14), 1418–1428. Scopus. https://doi.org/10.1056/NEJMsa0803563
Johnson, J. K., Hohman, J., Stilphen, M., Bethoux, F., & Rothberg, M. B. (2021). Functional Recovery Rate: A Feasible Method for Evaluating and Comparing Rehabilitation Outcomes Between Skilled Nursing Facilities. Journal of the American Medical Directors Association, 22(8), 1633-1639.e3. Scopus. https://doi.org/10.1016/j.jamda.2020.09.037
Juwita, H., L.Sjattar, E., Majid, A., & Lukman, S. (2021). Kolaborasi Multidisiplin Pelaksanaan Discharge Planning. Aksiologiya: Jurnal Pengabdian Kepada Masyarakat, 5(4), 524. https://doi.org/10.30651/aks.v5i4.5079
Langhorne, P., Ramachandra, S., & Collaboration, S. U. T. (2020). Organised inpatient (stroke unit) care for stroke: Network meta‐analysis. https://doi.org/10.1002/14651858.CD000197.pub4.
Lee, J. S., Khan, A. D., Dorlac, W. C., Dunn, J., McIntyre, R. C., Wright, F. L., Platnick, K. B., Brockman, V., Vega, S. A., Cofran, J. M., Duero, C., & Schroeppel, T. J. (2022). The patient’s voice matters: The impact of advance directives on elderly trauma patients. Journal of Trauma and Acute Care Surgery, 92(2), 339–346. Scopus. https://doi.org/10.1097/TA.0000000000003400
Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., Wang, Z., Erwin, P. J., Sylvester, T., Boehmer, K., Ting, H. H., Murad, M. H., Shippee, N. D., & Montori, V. M. (2014). Preventing 30-Day Hospital Readmissions: A Systematic Review and Meta-analysis of Randomized Trials. JAMA Internal Medicine, 174(7), 1095. https://doi.org/10.1001/jamainternmed.2014.1608
Naylor, M. D., Shaid, E. C., Carpenter, D., Gass, B., Levine, C., Li, J., Malley, A., McCauley, K., Nguyen, H. Q., Watson, H., Brock, J., Mittman, B., Jack, B., Mitchell, S., Callicoatte, B., Schall, J., & Williams, M. V. (2017). Components of Comprehensive and Effective Transitional Care. Journal of the American Geriatrics Society, 65(6), 1119–1125. https://doi.org/10.1111/jgs.14782
Permenkes No. 3 Tahun 2023. (n.d.). Database Peraturan | JDIH BPK. Retrieved July 5, 2026, from http://peraturan.bpk.go.id/details/275518/permenkes-no-3-tahun-2023
Permenkes No 26 Tahun 2021, Permenkes No 26 Tahun 2021 (2021).
Veronese, M., Vellone, E., Alvaro, R., & Pucciarelli, G. (2025). The transitional care from hospital to home for stroke survivors and their caregivers: A systematic review. Journal of Vascular Nursing, 43(2), 86–98. https://doi.org/10.1016/j.jvn.2025.03.002
World Health Organization. (2021). Global Patient Safety Action Plan 2021-2030: Towards Eliminating Avoidable Harm in Health Care. https://www.who.int/publications/i/item/9789240032705
