Background Effective discharge planning is vital for palliative care patients so they can be cared for, and ultimately die, in their preferred location. Delayed discharges can result in ineffective use of resources and cause distress to patients. This audit looked into causes of delayed discharge from a specialist palliative care unit, and examined ways to improve the discharge process to ameliorate these factors. Methods Notes from the first 26 admissions to a specialist palliative care unit from 1 January 2011 were examined. Incomplete or missing notes were excluded, as were admissions for end of life care. Information recorded included patient demographics, reason for admission, discharge destination, proposed and actual date of discharge, and reasons for any delay. Results 44% of patients' discharges were delayed 3–57 days, leading to 164 extra bed days, with an average of 10 days delay per admission. Three patients were delayed due to medical causes; each of these had multiple reasons for their delay. Four of the five patients delayed for non-medical reasons were held-up by delayed package of care (POC) provision; late referral to social services was implicated in 75%. Men are 2.1 more times likely to be delayed than women and patients over 75 years of age are 2.1 times more likely to be delayed. Conclusion Causes for delayed discharge are varied and complex. Improvements in POC provision would reduce this major cause of delay. Discharge planning should begin early, with adequate information for patients to be able to make an informed decision. Increased efficiency in the multi-disciplinary team would increase the effectiveness of the discharge process. Identification of certain higher risk demographics should help to focus improvements in the discharge process. This audit has identified important trends, which, if improved, may save resources and improve patient satisfaction.
Title Nursing staff and allied health professionals perceptions of delayed discharges from a specialist palliative care unit. Background Discharge delays from specialist palliative care units are a common problem for patients. A delay in discharge, for whatever reason, can have significant implications for patients, and can mean that they are not cared for in their preferred place. There has been little research looking specifically at discharge delays from specialist palliative care units. Nursing staff and allied health professionals are often at the forefront of discharge planning, and little is known on their beliefs about this. Aim To investigate the perceptions of nursing staff and allied health professionals about discharge delays from a specialist palliative care unit. Methods The participants (nursing staff and allied health professionals) worked in a specialist palliative care unit in South Central England, and were involved in discharge planning for inpatients. The critical incident technique was used as the methodology. One-to-one interviews were audio taped, and analysed by the process of thematic analysis. Six participants were interviewed in total (five nursing staff and one allied health professional). The critical incident was defined as the ‘delayed discharge’, and participants talked about actual cases where a patient's discharge from the unit had been delayed. Results The results were broadly split into six themes: patient and family issues, staff issues, communication, community care, equipment and ethical issues. Communication was raised so frequently by participants and was so pervasive that it was separated into a stand-alone theme. Conclusions The results illustrate the complexities of the discharge planning process and discharge delays, and there is unlikely to be a single causative factor in a patient's delayed discharge. It is a source of distress to patients, families and staff. Practical issues need to be addressed, and communication is vital at all stages.
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