Abstract
Background: 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. Methods: 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. Results: 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&E (Accident & 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. Conclusion: 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.
Highlights
Over the past few decades, healthcare systems in both developed and developing countries have been subjected to increasingly challenging financial scenarios, more so against the background of the 2008-2009 financial and macro-economic crises.[1]
Building Conceptual and Operational Definitions for Delayed Discharges All articles included in this study were analysed in an effort to extract data related to conceptual and operational definitions of delayed discharges
Other information was extracted with the purpose of establishing a link between the definitions provided by different authors and country of origin, types of health systems, causes and effects of delayed discharges and healthcare costs
Summary
Over the past few decades, healthcare systems in both developed and developing countries have been subjected to increasingly challenging financial scenarios, more so against the background of the 2008-2009 financial and macro-economic crises.[1] European Union (EU) countries are increasingly focusing their efforts on an overall reduction in public sector expenditure on healthcare through the elimination of resource waste and inefficiency.[2] Such issues have mainly revolved around events related to the admission and discharge of patients in acute hospital settings. The efficiency of hospital processes, in relation to the admission and discharge processes, has attracted the attention of scholars in the field of health services in a bid to ensure efficiency and effectiveness without jeopardizing quality of care.[2]. The delayed discharge of hospital patients has been singled out as a major factor that hinders acute care settings from reaching optimal levels of performance.[5]
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