Barriers to Earlier Hospital Discharge: What Matters Most?

Peter, David J.; Harte, Brian

doi:10.12788/jhm.3094

Cited by 2 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The total number of excess patient-days because of prolonged admission equated to an approximate 15.6% of total admission days (93 out of 596 days). 6 highlights that more than half (52%) of discharged patients vacated their bed between 14:00 and 17:00. In terms of admission times, almost two-thirds of patients are admitted to wards after 20:00 (66%).…”

Section: Length Of Stay Per Medical Firmmentioning

confidence: 99%

“…Extrinsic factors include the lack of availability of post-acute beds at step-down facilities and delays in patient transport (4). Intrinsic factors include increased patient numbers, inadequate communication between providers, senior ward round frequency and style, awaiting senior recommendations for care, completion of necessary investigations and a lack of policies and standard operating procedures to guide timely discharges (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Analysis of Patient flow through general medical wards at a Tertiary Academic Hospital

Hunter,

Peters,

Khumalo

et al. 2023

Preprint

View full text Add to dashboard Cite

Background The challenge of enhancing service delivery to meet the needs of a growing and aging population, whilst minimizing expense, is a global concern. There is an urgent need to understand and quantify systemic gaps in the efficient delivery of healthcare services. Movement of patients through a health establishment is a complex activity reliant upon multi-actor co-ordination across departments. Stagnation has negative impacts on both staff and patients by increasing risks of adverse outcomes, staff frustration and job dissatisfaction. An inefficient discharge process can be a significant barrier to timely patient movement. Discharge planning has been adopted in many high-income countries to ensure standardization and process efficiency. However, the heterogeneity of healthcare facilities and their challenges needs to be understood to implement targeted and effective discharge planning. Methods We conducted a retrospective cohort study at a central hospital in the Western Cape, South Africa to assess the journey of medical patients from admission to discharge. We reviewed the folders of eligible patients using a data-extraction tool to ascertain reasons for admission and barriers to timely discharge. Results Among 86 patient folders reviewed, cumulatively accounting for 596 in-patient days, a difference in the median length of in-patient stay between medical firms (p = 0.042) was noted. The shortest length of stay corresponded to firms with the greatest proportion of daily senior oversight (defined as documented patient reviews by a registrar, medical officer and/or consultant independently or in addition to reviews done for the day by interns and students). Firm 5 had a median length of stay of 5 days with 64% senior oversight and Firm 2 with the lowest senior oversight at 26% had amongst the longest lengths of stay at 8 days. While 52% of patients vacated their beds between 14:00 and 17:00, 66% of patients were admitted after 20:00. Reasons for prolonged admission were variable, and attributable to a range of different disciplines across the multidisciplinary team. Conclusion Delays in discharge were multi-factorial, highlighting the need for a standardized discharge process. Increasing senior oversight could assist in enhancing efficient patient movement.

show abstract

Section: Length Of Stay Per Medical Firmmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of Patient flow through general medical wards at a Tertiary Academic Hospital

Hunter,

Peters,

Khumalo

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Extrinsic factors include the lack of availability of post-acute beds at step-down facilities and delays in patient transport [ 4 ]. Intrinsic factors include increased patient numbers, inadequate communication between providers, senior ward round frequency and style, awaiting senior recommendations for care, completion of necessary investigations and a lack of policies and standard operating procedures to guide timely discharges [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of patient flow and barriers to timely discharge from general medical wards at a tertiary academic hospital in Cape Town, South Africa

Hunter,

Peters,

Khumalo

et al. 2024

BMC Health Serv Res

View full text Add to dashboard Cite

Background Movement of patients through a health establishment is a complex activity reliant upon multi-actor co-ordination across departments. The challenge of enhancing service delivery to meet the needs of a growing and aging population, whilst minimizing expense, is a global concern. There is an urgent need to understand and quantify systemic gaps in the efficient delivery of healthcare services. Stagnation of patient flow has negative impacts on both staff and patients by increasing risks of adverse outcomes, staff frustration and job dissatisfaction. An inefficient discharge process can be a significant barrier to timely patient movement. Methods A retrospective cohort study was conducted at a tertiary, academic hospital in the Western Cape, South Africa to assess the journey of medical patients from admission to discharge across the five different medical teams (firms) within the general medicine department. Consecutive sampling was used to capture all eligible adult medical in-patients admitted from the emergency department (ED) to general medicine from the 11th – 20th April 2023 and discharged up until the 30th of April 2023. We reviewed the patient notes (folders) of these individuals using a data-extraction tool to ascertain reasons for admission and barriers to timely discharge. Results Among 86 patient folders reviewed, cumulatively accounting for 596 in-patient days, a difference in the median length of in-patient stay between medical firms (p = 0.042) was noted. The shortest length of stay corresponded to firms with the greatest proportion of daily senior staff oversight (defined as documented patient reviews by a registrar, medical officer and/or consultant independently or in addition to reviews done for the day by interns and/or students). While 52% of patients vacated their beds between 14:00 and 17:00, 66% of patients were admitted after 20:00. Reasons for prolonged admission were variable, and attributable to a range of different disciplines across the multidisciplinary team. Conclusion Whilst this study did not evaluate the appropriateness of chosen medical management but rather systemic drivers affecting patient movement and barriers to timely discharge, the delays in discharge were noted to be multi-factorial including facets across the efficient delivery of medical care, availability of resources and the internal operational frameworks for the institution. Understanding the need to optimize internal process efficiencies with regards to prompt acquisition of investigations, improvement of senior staff oversight and the creation of a standardized discharge process, could enhance efficient patient movement.

show abstract

Barriers to Earlier Hospital Discharge: What Matters Most?

Abstract: Every system is perfectly designed to get the results it gets." -W. Edwards Deming inspired quote 1

Cited by 2 publications

References 22 publications

Analysis of Patient flow through general medical wards at a Tertiary Academic Hospital

Analysis of Patient flow through general medical wards at a Tertiary Academic Hospital

Analysis of patient flow and barriers to timely discharge from general medical wards at a tertiary academic hospital in Cape Town, South Africa

Contact Info

Product

Resources

About