All dressed up but nowhere to go? Delayed hospital discharges and older people

Glasby, Jon; Littlechild, Rosemary; Pryce, K.

doi:10.1258/135581906775094208

Cited by 58 publications

(80 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Little analysis of these delays has been published recently, and there is considerable heterogeneity amongst older studies, many of which have methodological flaws. 8 Therefore, we performed an in-depth prospective study to define the causes and financial cost of delays in discharges from the general medical wards of a metropolitan teaching hospital. We show that the majority of patients experienced delays and that these delays interfered with the discharge of half the patients.…”

Section: Discussionmentioning

confidence: 99%

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

Hendy¹,

Patel²,

Kordbacheh

et al. 2012

Clinical Medicine

View full text Add to dashboard Cite

-Delayed patient discharge will likely exacerbate bed shortages. This study prospectively determined the frequency, causes and potential cost implications of delays for 83 consecutive patients, who were inpatients for a total of 888 days. 65% of patients experienced delay whilst awaiting a service. 48% of patients experienced delays that extended their discharge date. Discharge delays accounted for 21% of the cohort's inpatient stay, at an estimated cost of £565 per patient; 77% of these hold-ups resulted from delays in the provision of social and therapy requirements. Discharge delays are costly for hospitals and depressing for patients. Investment is required to enable health and social-care professionals to work more closely to improve the patient journey. KEY WORDS: delayed discharge, patient experience, patient journey, Quality, Innovation, Productivity and Prevention (QIPP) agenda IntroductionThe NHS is increasingly criticised for bed shortages, delayed elective admissions and long waiting lists. 1 The number of admissions to secondary care in the UK is growing year-on-year 2 because of limited out-of-hours services in primary care, a greater number of patients who expect proactive hospital care and, most significantly, an increasing population of older people. Older patients are often frail and have complex social and healthcare needs, resulting in a prolonged inpatient stay. 3 At the same time as hospital admissions have increased, there has been a decrease in the number of hospital inpatient beds. 4 This has been off-set by efficiency directives, with a reduction in the average inpatient stay from 11.7 days in 1980 to 6.8 days in 2000. 5 One hospital has recently reported a reduction in average inpatient stay to 5.3 days, coincident with the introduction of twice-daily consultant ward rounds. 6 Nevertheless, demand frequently outstrips supply. Hospitals are often 'full' , with deleterious effects that include delayed patient flow, failure of specialty ward-based hospital systems and delayed or cancelled elective admissions.Bed pressures are increased by 'delayed discharges' , which exacerbate patients' exposure to hospital-acquired infections, low mood and increasing loss of functional capacity. Remedying such delays would provide both cost savings and better quality of care, in line with the NHS Quality, Innovation, Productivity and Prevention (QIPP) agenda.The aims of this longitudinal prospective study were to determine the length of inappropriate delay experienced by patients in a general medical ward prior to discharge, to identify common causes of delay and to estimate the financial implications of discharge delays. MethodsThe Chelsea and Westminster Hospital, London, admits both medical and surgical patients to an acute admissions unit (AAU), from which 60% are discharged home within 48 hours. The remainder are transferred to base wards. The majority of these patients require specialist elderly care that cannot be provided by single organ specialists.For seven weeks beginning 12 October ...

show abstract

Section: Discussionmentioning

confidence: 99%

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

Hendy¹,

Patel²,

Kordbacheh

et al. 2012

Clinical Medicine

View full text Add to dashboard Cite

show abstract

“…There is scarce information regarding the non-English-speaking groups in previous studies. 1 We may speculate that these patients may have more communication problems with health professionals regarding their symptoms, complications or other ailments that may lead to delayed identification or treatment. However, it is also possible that more patients from an NESB were referred for discharge planning based on their medical problems.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…However, recent reviews have found the literature to be of poor quality, with a tendency to neglect patient and family perspectives. 51,52 The provision of rehabilitation services and residential care places, internal hospital processes, and co-ordination and communication with social care service processes and staff are all common causes of delay. This can be exacerbated by BACKGROUND, CONTEXT AND SCOPE discharge planning being delayed until the patient is ready for hospital discharge.…”

Section: Delayed Dischargesmentioning

confidence: 99%

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Hanratty

Lowson

Grande

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

BackgroundThe end of life may be a time of high service utilisation for older adults. Transitions between care settings occur frequently, but may produce little improvement in symptom control or quality of life for patients. Ensuring that patients experience co-ordinated care, and moves occur because of individual needs rather than system imperatives, is crucial to patients’ well-being and to containing health-care costs.ObjectiveThe aim of this study was to understand the experiences, influences and consequences of transitions between settings for older adults at the end of life. Three conditions were the focus of study, chosen to represent differing disease trajectories.SettingEngland.ParticipantsThirty patients aged over 75 years, in their last year of life, diagnosed with heart failure, lung cancer and stroke; 118 caregivers of decedents aged 66–98 years, who had died with heart failure, lung cancer, stroke, chronic obstructive pulmonary disease or selected other cancers; and 43 providers and commissioners of services in primary care, hospital, hospice, social care and ambulance services.Design and methodsThis was a mixed-methods study, composed of four parts: (1) in-depth interviews with older adults; (2) qualitative interviews and structured questionnaire with bereaved carers of older adult decedents; (3) telephone interviews with care commissioners and providers using case scenarios derived from the interviews with carers; and (4) analysis of linked Hospital Episode Statistics (HES) and mortality data relating to hospital admissions for heart failure and lung cancer in England 2001–10.ResultsTransitions between care settings in the last year of life were a common component of end-of-life care across all the data sets that made up this study, and many moves were made shortly before death. Patients’ and carers’ experiences of transitions were of a disjointed system in which organisational processes were prioritised over individual needs. In many cases, the family carer was the co-ordinator and provider of care at home, excluded from participation in institutional care but lacking the information and support to extend their role with confidence. The general practitioner (GP) was a valued, central figure in end-of-life care across settings, though other disciplines were critical of GPs’ expertise and adherence to guidelines. Out-of-hours services and care homes were identified by many as contributors to unnecessary transitions. Good relationships and communication between professionals in different settings and sectors was recognised by families as one of the most important influences on transitions but this was rarely acknowledged by staff.ConclusionsDevelopment of a shared understanding of professional and carer roles in end-of-life transitions may be one of the most effective ways of improving patients’ experiences. Patients and carers manage many aspects of end-of-life care for themselves. Identifying ways to extend their skills and strengthen their voices, particularly in hospital settings, would be welcomed and may reduce unnecessary end-of-life transitions. Why the experiences of carers appear to have changed little, despite the implementation of a range of relevant policies, is an important question that has not been answered. Recommendations for future research include the relationship between policy interventions and the experiences of end-of-life carers; identification of ways to harmonise understanding of the carers’ role and strengthen their voice, particularly in hospital settings; identification of ways to reduce the influence of interprofessional tensions in end-of-life care; and development of interventions to enhance patients’ experiences across transitions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

All dressed up but nowhere to go? Delayed hospital discharges and older people

Abstract: The evidence, as it currently stands, raises a number of issues about current hospital discharge policy, supporting some aspects of the current government agenda in England, but questioning other aspects.

Cited by 58 publications

References 0 publications

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

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

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Contact Info

Product

Resources

About