Impact and experiences of delayed discharge: A mixed‐studies systematic review

Abstract

BackgroundThe impact of delayed discharge on patients, health‐care staff and hospital costs has been incompletely characterized.AimTo systematically review experiences of delay from the perspectives of patients, health professionals and hospitals, and its impact on patients’ outcomes and costs.MethodsFour of the main biomedical databases were searched for the period 2000‐2016 (February). Quantitative, qualitative and health economic studies conducted in OECD countries were included.ResultsThirty‐seven papers reporting data on 35 studies were identified: 10 quantitative, 8 qualitative and 19 exploring costs. Seven of ten quantitative studies were at moderate/low methodological quality; 6 qualitative studies were deemed reliable; and the 19 studies on costs were of moderate quality. Delayed discharge was associated with mortality, infections, depression, reductions in patients’ mobility and their daily activities. The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care and well‐being. Extra bed‐days could account for up to 30.7% of total costs and cause cancellations of elective operations, treatment delay and repercussions for subsequent services, especially for elderly patients.ConclusionsThe poor quality of the majority of the research means that implications for practice should be cautiously made. However, the results suggest that the adverse effects of delayed discharge are both direct (through increased opportunities for patients to acquire avoidable ill health) and indirect, secondary to the pressures placed on staff. These findings provide impetus to take a more holistic perspective to addressing delayed discharge.

Patient and caregiver experience with delayed discharge from a hospital setting: A scoping review

“…6,9 Delayed hospital discharge has been associated with decreased abilities to participate in activities of daily living, frailty, increased age, high comorbidity (eg obesity and stroke), cognitive impairment, dependency and behavioural challenges. [9][10][11][12]14,15 One review has been published that included a brief summary of experiences of patients with delayed hospital discharge; however, the main focus of the review was on the impacts of delayed hospital discharge on patient health outcomes, evaluating associated costs and qualitatively assessing the impacts on patients, providers and hospitals. 15 To address quality and safety concerns, health-care delivery in the developed world is striving to become more patient-and family-centred by capturing and addressing the needs and priorities of people and their families.…”

“…[9][10][11][12]14,15 One review has been published that included a brief summary of experiences of patients with delayed hospital discharge; however, the main focus of the review was on the impacts of delayed hospital discharge on patient health outcomes, evaluating associated costs and qualitatively assessing the impacts on patients, providers and hospitals. 15 To address quality and safety concerns, health-care delivery in the developed world is striving to become more patient-and family-centred by capturing and addressing the needs and priorities of people and their families. 16 Taking a person-centred approach to care delivery is particularly important during care transitions when patients and caregivers are often at their most vulnerable.…”

“…Briefly, patients experiencing delayed hospital discharge generally have complex health needs including physical and mental impairment . Delayed hospital discharge has been associated with decreased abilities to participate in activities of daily living, frailty, increased age, high comorbidity (eg obesity and stroke), cognitive impairment, dependency and behavioural challenges . One review has been published that included a brief summary of experiences of patients with delayed hospital discharge; however, the main focus of the review was on the impacts of delayed hospital discharge on patient health outcomes, evaluating associated costs and qualitatively assessing the impacts on patients, providers and hospitals …”

Delay in Hospital Discharge of Trauma Patients: A Prospective Observational Study

“…The National Health Service (NHS) of England experiences approximately £100 m per year in costs associated with delayed discharge [7]. The increased cost of delayed discharged was reported by different studies and was attributed to occupying beds, needing to pay for nursing staff and other administrative costs [8][9][10][11]. In a study done by Thomas S et al in the USA, the total cost of delayed discharge per year was reported to be at about $715,403 [9].…”

“…University hospitals in Egypt have a limited budget and they often provide free services to the public [12,13]. Inappropriate bed use and prolonged stay increase the nancial burden on the health services especially in Egypt, where hospital admissions account for a signi cant amount of total healthcare costs in Egypt [6][7][8][9][10][11][13][14][15]. Therefore, improvements in acute care bed management could result in signi cant savings.…”