Optimising the discharge process in internal medicine in Québec: A qualitative interpretive descriptive study to understand the challenges faced by healthcare professionals.

Optimising the discharge process for internal medicine programs is a challenge given multiple social and practical constraints in transitions from hospital to home. The objective of this study is to explore healthcare professionals' perspectives on discharge processes in internal medicine within a context of organisational reform. This is an interpretive descriptive qualitative study using in-depth individual interviews with healthcare providers. Seventeen semi-structured interviews were conducted. The study comprised a sample of 18 healthcare professionals working on two internal medicine wards in an acute care teaching hospital in Quebec. A conceptual framework comprising core aspects of the discharge process (planning, coordination, teaching and outcomes) guided data collection and analysis. Thematic analysis was applied to analyse the data. Major themes were developed by contrasting empirical data and the conceptual framework. Five themes were developed (1) Iterative discharge planning; (2) Patient and family engagement in discharge planning and discharge readiness, (3) Lack of time for discharge teaching, (4) Discharge coordination and the placement of patients and (5) Inequitable social support and resources and risk of readmission. This study highlights the inter-relationship between discharge readiness and phases of the discharge process, in particular planning and coordination. Iterative planning along with strategies to coordinate discharge constitute efforts to ensure flexible processes that respond to patients' needs and preferences. Challenges persist for healthcare professionals regarding autonomy and resources, along with reduced opportunities for patient and family engagement in decision-making.