abstract: 'Introduction The burden of childhood mortality continues to be born

  largely by low-income and middle-income countries. The critical

  postdischarge period has been largely neglected despite evidence that

  mortality rates during this period can exceed inpatient mortality rates.

  However, there is a paucity of data on the paediatric discharge process

  from the perspective of the healthcare provider. Provider perspectives

  may be important in the development of an improved understanding of the

  barriers and facilitators to improving the transition from hospital to

  home.

  Objectives To explore healthcare providers'' and facility administrators''

  perspectives of the paediatric discharge process with respect to: (1)

  current procedures, (2) barriers and challenges, (3) ideas for change,

  (4) facilitators for change and (5) the importance of discharge

  planning.

  Design A qualitative exploratory approach using focus groups (14) and

  in-depth interviews (7).

  Setting This study was conducted at seven hospitals providing paediatric

  care in Uganda.

  Results Current discharge procedures are largely based on

  hospital-specific protocols or clinician opinion, as opposed to national

  guidelines. Some key barriers to an improved discharge process included

  caregiver resources and education, critical communication gaps,

  traditional practices, and a lack of human and physical resources.

  Teamwork and motivation to see improved paediatric transitions to home

  were identified as facilitators to implementing the ideas for change

  proposed by participants. The need for a standardised national policy

  guiding paediatric discharges, implemented through education at many

  levels and coupled with appropriate community referral and follow-up,

  was broadly perceived as essential to improving outcomes for children.

  Conclusions Although significant challenges and gaps were identified

  within the current health system, participants'' ideas and the identified

  facilitators provide a significant basis from which change may occur.

  This work can facilitate the development of sustainable and effective

  interventions to improve postdischarge outcomes in Uganda and other

  similar settings.'
affiliation: 'Wiens, MO (Corresponding Author), BC Childrens Hosp, Ctr Int Child Hlth,
  Vancouver, BC, Canada.

  Wiens, MO (Corresponding Author), Mbarara Univ Sci \& Technol, Fac Med, Mbarara,
  Uganda.

  Nemetchek, Brooklyn; Owilli, Alex Olirus; Fowler-Kerry, Susan, Univ Saskatchewan,
  Coll Nursing, Saskatoon, SK, Canada.

  Khowaja, Asif, Univ British Columbia, Sch Populat \& Publ Hlth, Vancouver, BC, Canada.

  Kavuma, Anthony; Kabajaasi, Olive; Jacob, Shevin T.; Kenya-Mugisha, Nathan, Walimu,
  Mbarara, Uganda.

  Ansermino, J. Mark, Univ British Columbia, Dept Anesthesiol Pharmacol \& Therapeut,
  Vancouver, BC, Canada.

  Ansermino, J. Mark; Wiens, Matthew O., BC Childrens Hosp, Ctr Int Child Hlth, Vancouver,
  BC, Canada.

  Jacob, Shevin T., Univ Liverpool Liverpool Sch Trop Med, Dept Clin Serv, Liverpool,
  Merseyside, England.

  Kabakyenga, Jerome, Mbarara Univ Sci \& Technol, Maternal Newborn \& Child Hlth
  Inst, Mbarara, Uganda.

  Wiens, Matthew O., Mbarara Univ Sci \& Technol, Fac Med, Mbarara, Uganda.'
article-number: e029526
author: Nemetchek, Brooklyn and Khowaja, Asif and Kavuma, Anthony and Kabajaasi, Olive
  and Owilli, Alex Olirus and Ansermino, J. Mark and Fowler-Kerry, Susan and Jacob,
  Shevin T. and Kenya-Mugisha, Nathan and Kabakyenga, Jerome and Wiens, Matthew O.
author-email: mowiens@outlook.com
author_list:
- family: Nemetchek
  given: Brooklyn
- family: Khowaja
  given: Asif
- family: Kavuma
  given: Anthony
- family: Kabajaasi
  given: Olive
- family: Owilli
  given: Alex Olirus
- family: Ansermino
  given: J. Mark
- family: Fowler-Kerry
  given: Susan
- family: Jacob
  given: Shevin T.
- family: Kenya-Mugisha
  given: Nathan
- family: Kabakyenga
  given: Jerome
- family: Wiens
  given: Matthew O.
da: '2023-09-28'
doi: 10.1136/bmjopen-2019-029526
files: []
issn: 2044-6055
journal: BMJ OPEN
keywords: Pediatrics; Patient Discharge; Qualitative Research; Uganda
keywords-plus: CHILDREN
language: English
month: SEP
number: '9'
number-of-cited-references: '12'
orcid-numbers: 'Kabakyenga, Jerome/0000-0003-1912-1032

  Kenya Mugisha, Nathan/0000-0002-2100-1833

  Derksen, Brooklyn/0000-0002-7842-3287

  Ansermino, J Mark/0000-0001-8427-2035

  Jacob, Shevin/0000-0003-2425-9394

  Wiens, Matthew/0000-0002-3287-5181'
papis_id: cdc67653586410e98c60c2119761693d
ref: Nemetchek2019exploringhealthcare
researcherid-numbers: 'Jacob, Shevin/CAF-0449-2022

  Wiens, Matthew/J-9249-2019

  Kabakyenga, Jerome/IXN-6998-2023

  '
times-cited: '4'
title: 'Exploring healthcare providers'' perspectives of the paediatric discharge
  process in Uganda: a qualitative exploratory study'
type: article
unique-id: WOS:000497787600192
usage-count-last-180-days: '1'
usage-count-since-2013: '2'
volume: '9'
web-of-science-categories: Medicine, General \& Internal
year: '2019'