Enhancing Predischarge Decision-Making: Tools for Occupational Therapists

Deciding whether to conduct a predischarge home visit is one of the most critical—and sometimes challenging—tasks for occupational therapists (OTs) working in hospital settings. A new study addresses this challenge by evaluating a structured support tool designed to guide and improve this decision-making process.

What the Study Found

Researchers introduced a decision-making support tool across five Australian metropolitan hospitals, aiming to help OTs systematically decide when a home visit before discharge is warranted. Here are the key findings:

• The tool improved the accuracy of decision-making. OTs were better able to identify which patients would benefit most from a home visit, regardless of their prior experience.
• Confidence and ease in decision-making did not change significantly among therapists using the tool—likely because many participants were already confident, experienced clinicians.
• Reliability was rated as moderate (Fleiss’ kappa = 0.51), and internal consistency was strong (α = 0.83 after one item was removed).
• Clinical utility received positive feedback: the tool was rated as easy and timely to use, supporting therapists’ workflow and communication.

Why Decision-Making Support Tools Matter

• Home visits are resource-intensive but can be crucial for safe, effective discharge planning.
• Without guidance, decision-making may be inconsistent, potentially resulting in missed opportunities or unnecessary visits.
• Tools that provide structured, evidence-based criteria help standardize practice, ensure high-impact resource use, and support less experienced therapists.

Suggestions for Occupational Therapists

1. Adopt Structured Tools:
Consider integrating decision-support tools like the one in this study into predischarge planning to provide consistent, evidence-based decisions.

2. Prioritize Where Most Needed:
Use clear criteria grounded in person, environment, and occupation frameworks to identify which clients will benefit most from a home visit.

3. Collaborate and Communicate:
Use the tool as a platform for discussion with multidisciplinary teams and clients, ensuring transparency and satisfaction with the process.

4. Support Professional Development:
Leverage decision-making tools as a training resource for novice therapists, increasing their confidence and skills in complex cases.

Call to Action: Make Evidence-Based Decisions Part of Your Practice

Structured support tools can enhance both the quality and impact of predischarge planning. OTs are encouraged to trial, adapt, and share decision-making resources within their teams and advocate for the adoption of these tools as part of routine practice.

Take Action: Evaluate how your team currently decides on predischarge home visits. Pilot a structured support tool with your next case discussion, and measure its impact on your decision-making and communication. Contribute your feedback to improve tools and practice guidelines.

REFERENCE:

Aplin, T., Godfrey, M., De Michele, L., Hoffman, A., Palmer, C., McCormack, C., Halin, C., King, M., Nix, J., Eldridge, A., & Eames, S. (2025). Supporting Occupational Therapists in Predischarge Home Visit Decision-Making: Development and Evaluation of a Decision-Making Support Tool. Occupational therapy international, 2025, 2296340. https://doi.org/10.1155/oti/2296340