| 
  • If you are citizen of an European Union member nation, you may not use this service unless you are at least 16 years old.

  • You already know Dokkio is an AI-powered assistant to organize & manage your digital files & messages. Very soon, Dokkio will support Outlook as well as One Drive. Check it out today!

View
 

Delayed Discharge

Page history last edited by PBworks 16 years, 8 months ago

Contents

 

 

Evidence Based Literature

 

Guidelines, Technology Assessments and Reports

 

Department of Health Publications

 

Websites on Delayed Discharge

 


 

Summary

 

What causes delayed discharge?  Rising demand and a reduction in the number of available beds have greatly increased the turnover in hospital. The pressure to increase this even further has led to the concept of inappropriately delayed discharge. [1]

 

A Scottish Executive research review identified the groups most at risk from delayed discharge;  [2]

The literature indicates that age is the strongest predictor of delayed discharge. It is widely accepted that older people are most at risk of delayed discharge, but a UK study suggests that those with multiple pathology, physical disability, stroke, incontinence and dementia were more likely to experience delayed discharge than other older people. Recent Australian research shows that the average length of stay (not necessarily inappropriate) was four times greater for people aged 65 years old and over with dementia than for all other people, whilst in New Zealand, a prospective study of all patients who were 15 years old and over admitted to acute medical beds found that people over 75, living alone and who were admitted with a 'cerebrovascular problem' (associated with stroke) were more likely to have a prolonged length of inappropriate stay. A study of people aged 64 years old and over in Sweden suggests that this group of the population are more likely to experience new medical problems requiring treatment after they have already been declared ready for discharge, thus further exacerbating and complicating their discharge from hospital.

 

Statistical returns in March 2002 indicated that 24.5% of delays were due to awaiting completion of an assessment of future care needs, 9.3% were awaiting social services funding for residential or home care, 25.4% were waiting for a care home placement and eight percent were waiting for a home care package. [3]

 

Furthermore, a 2006 analysis by the RCSE on surgical patients who were unable to be discharged from a surgical ward despite being surgically fit to leave reported; [4]

Data were collected on all surgical in-patients on a single day. Nine of 75 patients (12%) were surgical bed blockers. These patients were more likely to have been admitted as emergencies (P = 0.035) and were older (P < 0.01) than the remaining patients. They occupied 35% of the total 'bed-days' of the group as a whole with a median in-patient stay of 41 days compared with 2 days for the other patients. Due to problems in defining delayeddischarge Government figures probably underestimate the true numbers. Lack of intermediate care and social service provision are a major cause of bed blocking.

 

In 2004 the Department of Health introduced a toolkit for effective discharge in it they raise the issue that at least 80% of patients discharged from hospital can be classified as simple discharges: they are discharged to their own home and have simple ongoing health care needs which can be met without complex planning. Changing the way in which discharge occurs for this large group of patients will have a major impact on patient flow and effective use of bed capacity. It can mean the difference between a system where patients experience long delays or one where delays are minimal, with patients fully informed about when they will be able to leave hospital.[5]The potential impact of discharge planning was reviewed in a recent Cochrane Systematic Review; [6]

The impact of discharge planning on readmission rates, hospital length of stay, health outcomes, and cost to patients and health care providers is uncertain. Discharge planning is the development of a discharge plan for the patient prior to leaving hospital, with the aim of containing costs and improving patient outcomes. The development of a discharge plan is increasingly becoming part of an integrated package of care, making it difficult to study the effects of discharge planning alone. Although the impact of discharge planning may be small, it is possible that even a small reduction in length of stay or readmission rate could free up capacity for subsequent admissions in a health care system where there is a shortage of acute hospital beds.

 

A 2007 paper introducing the Delayed Discharge Project, in a general medicine setting of a New Zealand teaching hospital; [7]

Average length of stay (ALOS) dropped by 2.6 days (6.5 to 3.9), readmission rates did not rise, costs of service delivery dropped by US dollars 2.4 million, patient numbers increased by 145 (2445 to 2590), while bed numbers reduced from 56 to 32 and ward outliers all but disappeared, suggesting success. However, 2 years after the successful cost-saving measures were introduced the new system crashed as a result of additional bed closures and organisational restructures.

 

In 2003 the Government introduced a policy of reimbursement to tackle the problem of delayed discharge, a recent report on the short term impacts suggests that reimbursement appears to have speeded up hospital discharge but its impact, in terms of the quality of older people’s post-hospital support, is much more mixed. At one end of the spectrum, where health and social services have sound, working partnerships and a good range of community support, the implementation of reimbursement has needed little adjustment to local practice. At the other end, where services to support recovery are underdeveloped, efforts to speed up discharge are, in some cases, disempowering individuals and undermining their potential for improvement and rehabilitation. [8]

  


References

1.  Vetter, N.  Inappropriately delayed discharge from hospital: what do we know? HighWire Press  BMJ, 26 Apr 2003, vol. 326, no. 7395, p. 927-8.

2.  Scottish Executive. Delayed Discharge - Research Review on Tackling Delayed Discharge. 2004.

http://www.scotland.gov.uk/Publications/2004/10/20042/44591

 

3. Department of Health/Health and Social Care Joint Unit.  Reducing delayed discharges; regulatory impact assessment.  DOH, 2002.  http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_4007151

 

4.Benson-R-T, Drew-J-C, Galland-R-B. A waiting list to go home: an analysis of delayed discharges from surgical beds. Annals of the Royal College of Surgeons of England, {Ann-R-Coll-Surg- Engl}, Nov 2006, vol. 88, no. 7, p. 650-2.

 

5. Department of Health. Achieving timely simple discharge from hospital: A toolkit for the multi-disciplinary team.  DOH, 2004.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4088366

6. Shepperd S, Parkes J, McClaran J, Phillips C. Discharge planning from hospital to home. Cochrane Database of Systematic Reviews: Reviews 2004 Issue 1 John Wiley & Sons, Ltd Chichester, UK. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000313/frame.html 

7.Rae-Brendon, Busby-Wendy, Millard-Peter-H. Fast-tracking acute hospital care--from bed crisis to bed crisis. ProQuest Australian health review: a publication of the Australian Hospital Association, {Aust-Health-Rev}, Feb 2007, vol. 31, no. 1, p. 50-62.

 

8. Commission for Social Care Inspection. Leaving hospital: the price of delays.  London : CSCI, 2004. http://www.csci.org.uk/PDF/leaving_hospital.pdf

 

All references and sources available online as listed above were checked for availability 28th May ’07.

 

Comments (0)

You don't have permission to comment on this page.