Initiatives for improving delayed discharge from a hospital setting: a scoping review

Abstract

ObjectiveThe overarching objective of the scoping review was to examine peer reviewed and grey literature for best practices that have been developed, implemented and/or evaluated for delayed discharge involving a hospital setting. Two specific objectives were to review what the delayed discharge initiatives entailed and identify gaps in the literature in order to inform future work.DesignScoping review.MethodsElectronic databases and websites of government and healthcare organisations were searched for eligible articles. Articles were required to include an initiative that focused on delayed discharge, involve a hospital setting and be published between 1 January 2004 and 16 August 2019. Data were extracted using Microsoft Excel. Following extraction, a policy framework by Doern and Phidd was adapted to organise the included initiatives into categories: (1) information sharing; (2) tools and guidelines; (3) practice changes; (4) infrastructure and finance and (5) other.ResultsSixty-six articles were included in this review. The majority of initiatives were categorised as practice change (n=36), followed by information sharing (n=19) and tools and guidelines (n=19). Numerous initiatives incorporated multiple categories. The majority of initiatives were implemented by multidisciplinary teams and resulted in improved outcomes such as reduced length of stay and discharge delays. However, the experiences of patients and families were rarely reported. Included initiatives also lacked important contextual information, which is essential for replicating best practices and scaling up.ConclusionsThis scoping review identified a number of initiatives that have been implemented to target delayed discharges. While the majority of initiatives resulted in positive outcomes, delayed discharges remain an international problem. There are significant gaps and limitations in evidence and thus, future work is warranted to develop solutions that have a sustainable impact.

Understanding the Accuracy of Clinician Provided Estimated Discharge Dates

“…Hospital discharge planning is a complex process, requiring timely coordination of many medical and social support services [6,9,15,16]. Yet, no prior studies have collected and analyzed data comparing discharge predictions across all staff types involved in the patient's care.…”

“…Many hospitals have attempted to reduce discharge delays by forming multi-disciplinary discharge teams, assigning a dedicated discharge coordinator, or promoting nurse-led discharge [5][6][7][8]. To date, no method has proven superior in improving discharge outcomes, and these approaches are manual and inconsistently performed [9].…”

Delayed discharge for non-clinical reasons among stroke patients in a high-complexity hospital: A cross-sectional study

“…The destination at discharge was not related to the length of stay in our cases, and the literature consulted provides su cient evidence that in the case of stroke, the availability of long-stay recovery centers in the patients' area of residence does not determine their post-discharge referral, depending more on factors such as age or the complexity of the patient's condition [7]. Planning communication at discharge with the resource that will subsequently receive the patient, regardless of whether it is a residential center or the community, has proven to be an effective measure to promote continuity of care [38], avoid BB and reduce LOS [14]. Such communication should be standardized, possibly via the help of a liaison professional or by using technological means [14,38].…”

“…Planning communication at discharge with the resource that will subsequently receive the patient, regardless of whether it is a residential center or the community, has proven to be an effective measure to promote continuity of care [38], avoid BB and reduce LOS [14]. Such communication should be standardized, possibly via the help of a liaison professional or by using technological means [14,38]. In our cases, stroke patients who returned home after BB had a higher mean LOS, although this difference was not signi cant.…”

“…The BB phenomenon appears in any healthcare system, both in those with universal coverage funded by taxes and those funded by private insurance, such as in the United States [12]. It has negative consequences beyond the ine cient and inappropriate use of the acute hospital bed resource, such as increased risk of infections related to hospital stay, adverse events such as falls or medication errors, death, loss of functional capacity and negative emotional impact on patients and families who suffer from this situation [8,14]. Therefore, its study is relevant in patients affected by stroke and who are therefore at special risk of complications due to their advanced age and acquired disability.…”