To identify the reasons and determinants of discharge delay in acute care patients, information associated with delayed discharge was extracted from the medical record of 1958 patients in a tertiary referral hospital in New South Wales. A logistic regression model was used to examine the association between demographic factors and reasons for discharge delay. Delayed discharge was most commonly associated with the patient's medical conditions, delayed health care or medical consultation, delayed diagnostic services and delayed allied health services. Elderly patients, those living alone and patients from a non-English-speaking background were more likely to have these reasons for delayed discharge.THE INCREASING DEMAND for acute care hospital beds and a push for cost cutting requires efficient discharge planning. [1][2][3][4] Delayed discharge has become a major issue because it leads to unanticipated length of stay and bed block. 2,[5][6][7] Both the quality and cost-effectiveness of care may be compromised as a result. 3,8 In the Australian context, delayed discharge is a major reason for the unavailability of beds in major acute care hospitals. 4 Recent studies suggest a range of reasons for discharge delays. Generically, the reasons for discharge delay include medical issues, hospital factors, patient and carer needs, and issues related to accessing alternative care or social care. The more detailed reasons include complication of the patient medical condition, delay in receiving diagnostic services or results of investigations, transfer delays, a lack of rehabilitation places, awaiting home care, community packages or community services and patient-related factors. 1,2,7 However, the studies exploring the reasons for delayed discharges often had small sample sizes, or were studies examining selected patient populations or a particular ward in a hospital. Very few studies have comprehensively addressed the multifaceted problems of discharge delays in a heterogeneous acute patient population. What is known about the topic? Delayed discharge has become a major issue because it leads to unanticipated length of stay and bed block, reducing patient access.
What does this paper add?The reasons for delayed discharge were complex and associated with patients' demographic characteristics and clinical management processes.
What are the implications for practitioners?Patients from a non-English-speaking background and unmarried patients were likely to encounter more problems. Elderly patients and the patients with chronic health problems were more likely to experience difficulties in accessing alternative care. These groups need more attention in order to achieve timely discharge from acute care.
A study of the medical emergency team (MET) to explore communication within the team, leadership, handover, and MET resuscitation practice was performed using audiovisual recording in hospitals of Sydney South West Area Health Service, Sydney, Australia. In this article, we report on the process of data collection: the completion of 25 video recordings of MET calls across three of the six study hospitals. We describe how we gained entry into hospital environments to film events characterized by the unpredictability and uncertainties associated with resuscitating a patient and the strategies that we implemented during the fieldwork to develop and maintain rapport with both clinicians and managers. We describe how we addressed some of the practical constraints related to collecting audiovisual data at the point of acute care as well as their implications for the theoretical and methodological aspects of the study.
'Ongoing Assessment' and 'Re-evaluating Risk' occupied almost half of the MET nurses time, whereas 'Establishing Patient Acuity, the key activity in CA teams, occupied only 4%. These findings provide evidence of the roles of CCNs in the MET and suggest that education and training of MET nurses should support these roles.
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