A critical ethnography of the process of discharge decision-making for elderly patients

A critical ethnography of the process of discharge decision-making for elderly patients was conducted to examine the nature of the process over the total course of patients' hospital stays. The focus was on describing the timing and conditions of decision-making, the related activities of professionals, professionals' perceptions of the process, and the effects of the process on those involved and on the hospital organization. Data analysis demonstrated that the process is not intricately linked with patients' clinical progress, that often inaccurate assumptions about the importance of patient-related clinical and social factors and organizational parameters underlie decisions, and that professionals' perceptions of the process are shaped by organizational imperatives. In the current process, resources are used inefficiently and humanitarian and ethical consequences arise for participants. The analysis supports attempts to achieve greater congruence between the discharge decision process and the patient's clinical progress so that the fiscal and humanitarian goals of the hospital can be achieved.