An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care

Abstract

The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review.

Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

“…Τ he concept of delayed admission of patients to the intensive care unit (ICU) has attracted international research interest, due to its increasing incidence and its presumed negative impact on patient outcomes [ 1 , 2 ]. Delayed ICU admission refers to both the waiting time of patients who need critical care in non-ICU settings due to the unavailability of ICU beds and the difficulty of healthcare professionals in identifying timely critical deterioration of patients [ 3 ]. The primary reason for increased delayed ICU admission has been the increasing demand for critical care, due to population aging and the increasing number of patients expected to benefit from ICU admission [ 4 , 5 ].…”

Factors associated with delays in discharge for trauma patients at an urban county hospital

“… 11 Interpersonal factors include communication breakdowns, conflicting goals between teams and services and teamwork problems. 12 There is conflicting evidence over whether injury severity or comorbidities contribute to delays in discharge. 7 8 Despite considerable research, surprisingly little is known about what patient factors, such as age or housing status, affect delays in discharge.…”

Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays

“…Other factors reflecting organizational infrastructure, such as a lack of communication or coordination, appear to play a role. 25 Intensive care unit disposition delays lead to an overall increase in hospital LOS. 26 In our study, we did not observe a reduction in SICU or hospital LOS related to our research, although this decrease was neither expected nor a focus of our project.…”