Delayed discharge from rehabilitation after brain injury

Worthington, Andrew; Oldham, James

doi:10.1191/0269215506cr881oa

Cited by 19 publications

(22 citation statements)

References 6 publications

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“…In this context length of stay should not be confused with a need for continued rehabilitation and there may be non-clinical reasons for this finding. The authors' own recent investigations suggest that admission duration is often determined by availability of a discharge placement [64] and it is possible that older patients may either have more established family networks to offer care at home or may be easier to accommodate in longer term residential facilities.…”

Section: Discussionmentioning

confidence: 96%

Cost-benefits associated with social outcome from neurobehavioural rehabilitation

Worthington¹,

Matthews²,

Melia³

et al. 2006

Brain Injury

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Section: Discussionmentioning

confidence: 96%

Cost-benefits associated with social outcome from neurobehavioural rehabilitation

Worthington¹,

Matthews²,

Melia³

et al. 2006

Brain Injury

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“…Previous studies have shown high rates of delayed discharges among older adult services, 9,10 learning disability services 11 and brain injury services. 12 As far as we are aware, ours is the first study to directly compare delayed discharges in younger and older person’s services in a single trust. A finding of longer delays in discharge among younger people is of particular concern, as working-age adults are the largest group of mental health service users.…”

Section: Discussionmentioning

confidence: 97%

Delayed discharges in an urban in-patient mental health service in England

2014

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Aims and method To describe the clinical and demographic characteristics of all in-patients experiencing delayed discharge over 3 months in an English urban mental health National Health Service trust. We carried out a cross-sectional case record study with care coordinator questionnaire.Results Overall, 67 in-patients with delayed discharge occupied 18.6% of acute beds. Older in-patients were White, diagnosed with dementia and experienced relatively short admissions. Younger in-patients were often of Black and minority ethnic background with a psychotic diagnosis and long service contact, and sometimes experienced very long admissions. They were similar to a long-stay comparison group. The whole cohort was socially isolated and marginalised, and frequently misused alcohol.Clinical implications People with complex mental health problems can experience long stays in acute care settings. This particularly affects people with psychosis who are isolated in the community. Alcohol misuse is the most common complicating factor. There are insufficient community-oriented rehabilitation services to meet these patients’ diverse needs.

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“…These results suggested that this group of patients needs specific attention and assistance in order to foster social support and improve communication. 19,22 The only patient demographic factor which was a significant predictor for the four broad categories of the reasons was the patients' age. The fact that the current Charlson Index was a significant predictor of the alternative care problem was expected, as the need for alternative care related to having a chronic problem.…”

Section: Discussionmentioning

confidence: 99%

“…It provided comprehensive descriptions of the common reasons for delays in discharge while other studies have focused more narrowly on particular patient populations, wards or specific discharge issues. 16,18,22 The study used a standardised data collection tool with a predetermined list of reasons for delayed discharge. It also linked study data with administrative data.…”

Section: Discussionmentioning

confidence: 99%

Discharge delay in acute care: reasons and determinants of delay in general ward patients

Ou¹,

Young²,

Chen³

et al. 2009

Aust. Health Review

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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.

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Delayed discharge from rehabilitation after brain injury

Abstract: Delayed discharge remains a significant obstacle to the development of cost-effective care pathways for younger adults. Our study suggests that health and social services are not exploiting the UK government's legislation for flexible partnership working in this area.

Cited by 19 publications

References 6 publications

Cost-benefits associated with social outcome from neurobehavioural rehabilitation

Cost-benefits associated with social outcome from neurobehavioural rehabilitation

Delayed discharges in an urban in-patient mental health service in England

Discharge delay in acute care: reasons and determinants of delay in general ward patients

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