Defining Delayed Discharges of Inpatients and Their Impact in Acute Hospital Care: A Scoping Review

Abstract

<jats:p> <jats:bold>Background:</jats:bold> With the ever-increasing demand on acute healthcare, the hospital discharge process and delayed discharges are considered relevant in achieving optimal performance in clinical settings. The purpose of this paper is to review the literature to identify conceptual and operational definitions of delayed discharges, identify causes and effects of delayed discharges, and also to explore the literature for interventions aimed at decreasing the impact (in terms of reducing the number/rate of delays) of delayed discharges in acute healthcare settings. <jats:bold>Methods:</jats:bold> An extensive literature search yielded a total of 26 248 records. Sixty-four research articles were included in the scoping review after considering inclusion/exclusion criteria and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) search strategy. The following databases were utilized: Cochrane, EBSCO, PubMed, PubMed Central, Medline, and Web of Science. The search was carried out between January 2017 and March 2020 and covered literature ranging from 1990 to 2019. Results were reviewed by authors for duplicates and filtered using the inclusion/ exclusion criteria. Tables were created to classify the chosen articles (n = 64), allowing us to organise findings and results. <jats:bold>Results:</jats:bold> Conceptual and operational definitions were analysed. In turn, causes and effects of delayed discharges were extracted and represented in diagrammatic format, together with specific interventions used in acute healthcare settings to lessen the effect of delayed discharges. Operational definitions of delayed discharges were found to be more difficult to establish, particularly in the light of the vast number of different scenarios and workplace interventions uncovered in the literature. The main causes of delayed discharges were faulty organisational management, inadequate discharge planning, transfer of care problems, and age. The main effects were bed-blocking, A&amp;E (Accident &amp; Emergency) overcrowding, and financial implications. The main interventions included ‘discharge before noon’ initiative, ‘discharge facilitation tools,’ ‘discharge delay tracking’ mechanisms, and the role of general practitioners and social care staff. <jats:bold>Conclusion:</jats:bold> This paper fills a gap in the fragmented literature on delayed inpatient discharges by providing a researchbased perspective on conceptual and operational definitions, causes and effects, as well as interventions to minimize their impact. The findings and definitions are intended as points of reference for future research.</jats:p>

Development of an acute medical unit to optimize patient flow and early discharges in a tertiary care hospital in the United Arab Emirates

“…Procedural inefficiencies, including waiting for tests, investigations, and input from consult services, contribute to delays in discharges [ 27 , 28 ] A study examining causes of delayed discharge from the general medical wards of a metropolitan teaching hospital showed that 48.2% of patients experienced delays waiting for a service that extended their LOS [ 29 ]. The AMU received expedited access to imaging and diagnostic testing and interventions, which aided in timely decision-making.…”

Optimising the balance of acute and intermediate care capacity for the complex discharge pathway: Computer modelling study during COVID-19 recovery in England

“…Effectively managing intermediate care capacity is especially important in times of high COVID-19 incidence. First, insufficient capacity puts severe pressure on upstream services, propagating ‘blockages’ in patient flow that, in turn, lead to increased stress on the (more expensive) acute care bed base, emergency department overcrowding, cancellation of elective procedures, and ambulance offload delays [ 10 , 11 ]. Second, delays to acute discharge are known to be associated with negative patient outcomes, including reduced physical and mental wellbeing and increased risk of nosocomial infections and cognitive decline [ 12 ].…”

Optimising the balance of acute and intermediate care capacity for the complex discharge pathway: computer modelling study during COVID-19 recovery in England

“…Effectively managing intermediate care capacity is especially important in times of high COVID-19 incidence. First, insufficient capacity puts severe pressure on upstream services, propagating 'blockages' in patient flow that, in turn, lead to increased stress on the (more expensive) acute care bed base, emergency department overcrowding, cancellation of elective procedures, and ambulance offload delays [5,6]. Second, delays to acute discharge are known to be associated with negative patient outcomes, including reduced physical and mental wellbeing and increased risk of nosocomial infections and cognitive decline [7].…”