Delayed discharge from intellectual disability in-patient units

Devapriam, John; Gangadharan, Satheesh; Pither, Judith; Critchfield, Matthew

doi:10.1192/pb.bp.113.044388

Cited by 14 publications

(41 citation statements)

References 6 publications

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“…The following exclusion criteria were also applied to the articles identified through the database search: research focusing on mental health, maternal and child and adolescent health, and palliative care was excluded; delays may occur in those settings for different reasons, for example relapse of mental health disorders, and consequently, delays due to non‐medical reasons are difficult to determine . Abstracts, editorials, commentaries and book reviews were excluded because the review focused on primary research.…”

Section: Methodsmentioning

confidence: 99%

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

Rojas-García

Turner

Pizzo

et al. 2017

Health Expectations

216

205

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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.

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Section: Methodsmentioning

confidence: 99%

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

Rojas-García

Turner

Pizzo

et al. 2017

Health Expectations

216

205

View full text Add to dashboard Cite

show abstract

“…This goes together with the inevitable negative financial implications typically incurred -Intermediate care and 72-hours discharge target (Levin & Crighton, 2019) in such situations. [26][27][28][29] In England, there were on average 4000 patients a day who experienced some form of delay in transfer of care between 2013 and 2016. 30 This translated to approximately 115 000 bed days' worth of delayed care.…”

Section: Causes and Effects Of Delayed Dischargesmentioning

confidence: 99%

“…The impact of cost on acute hospital settings in the absence of such services is particularly pronounced 10,57 due to the bedblocking effects inevitably incurred. 5,28,58 An additional two more recent systematic reviews pertaining to cause and effect of delayed discharges were analysed. One such review 59 chose to tackle delayed discharges from a prevalence and cost perspective.…”

Section: Effects Of Delayed Discharges/interventionsmentioning

confidence: 99%

Defining Delayed Discharges of Inpatients and Their Impact in Acute Hospital Care: A Scoping Review

Micallef

Buttiġieġ

Tomaselli

et al. 2020

Int J Health Policy Manag

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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.

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“…7,8 Once in hospital, they are more likely to remain despite being deemed ready for discharge. 9 They are also more likely to be admitted into long-term care (LTC) facilities at a younger age, 10 and to die earlier. 11 It has been suggested that when individuals also have a mental health and/or addiction (MHA) disorder in addition to their disability, they encounter further complications with healthcare use.…”

Section: Introductionmentioning

confidence: 99%

Looking across health and healthcare outcomes for people with intellectual and developmental disabilities and psychiatric disorders: population-based longitudinal study

Lin

Balogh

Chung³

et al. 2020

Br J Psychiatry

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Background Intellectual and developmental disabilities (IDDs) and psychiatric disorders frequently co-occur. Although each has been associated with negative outcomes, their combined effect has rarely been studied. Aims To examine the likelihood of five negative health and healthcare outcomes for adults with IDD and mental health/addiction disorders (MHAs), both separately and together. For each outcome, demographic, clinical and system-level factors were also examined. Method Linked administrative data-sets were used to identify adults in Ontario, Canada, with IDD and MHA (n = 29 476), IDD-only (n = 35 223) and MHA-only (n = 727 591). Five outcomes (30-day readmission, 30-day repeat ED visit, delayed discharge, long-term care admission and premature mortality) were examined by logistic regression models with generalised estimating equation or survival analyses. For each outcome, crude (disorder groups only) and complete (adding biosocial covariates) models were run using a general population reference group. Results The IDD and MHA group had the highest proportions across outcomes for both crude and complete models. They had the highest adjusted ratios for readmissions (aOR 1.93, 95%CI 1.88–1.99), repeat ED visit (aOR 2.00, 95%CI 1.98–2.02) and long-term care admission (aHR 12.19, 95%CI 10.84–13.71). For delayed discharge, the IDD and MHA and IDD-only groups had similar results (aOR 2.00 (95%CI 1.90–2.11) and 2.21 (95%CI 2.07–2.36). For premature mortality, the adjusted ratios were similar for all groups. Conclusions Poorer outcomes for adults with IDD, particularly those with MHA, suggest a need for a comprehensive, system-wide approach spanning health, disability and social support.

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Delayed discharge from intellectual disability in-patient units

Cited by 14 publications

References 6 publications

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

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

Defining Delayed Discharges of Inpatients and Their Impact in Acute Hospital Care: A Scoping Review

Looking across health and healthcare outcomes for people with intellectual and developmental disabilities and psychiatric disorders: population-based longitudinal study

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