Patient and caregiver experience with delayed discharge from a hospital setting: A scoping review

Abstract

BackgroundDelayed hospital discharge occurs when patients are medically cleared but remain hospitalized because a suitable care setting is not available. Delayed discharge typically results in reduced levels of treatment, placing patients at risk of functional decline, falls and hospital‐related adverse events. Caregivers often take on an active role in hospital to mitigate these risks.ObjectiveThis scoping review aimed to summarize the literature on patient and caregiver experiences with delayed hospital discharge.Search strategySeven electronic databases and grey literature were searched using keywords including alternate level of care, delayed discharge, patients, caregivers and experiences.Inclusion criteriaIncluded articles met the following criteria: (a) patient or caregiver population 18 years or older; (b) delayed discharge from a hospital setting; (c) included experiences with delayed discharge; (d) peer‐reviewed or grey literature; and (e) published between 1 January 1998 and 16 July 2018.Data extractionData were extracted from the seven included articles using Microsoft Excel 2016 to facilitate a thorough analysis and comparison.Main resultsStudy themes were grouped into five elements of the delayed discharge experience: (1) overall uncertainty; (2) impact of hospital staff and physical environment; (3) mental and physical deterioration; (4) lack of engagement in decision making and need for advocacy; and (5) initial disbelief sometimes followed by reluctant acceptance.ConclusionThis review provides a foundation to guide future research, policies and practices to improve patient and caregiver experiences with delayed hospital discharge, including enhanced communication with patients and families and programmes to reduce deconditioning.

An alternate level of care plan: Co‐designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges

“…Thus, their care needs are considered low priority in favour of patients who require acute care. Since patients who are designated as ALC are often older adults with ongoing care needs, an absence or decrease in services can lead to functional decline, 2,6,[14][15][16] falls, 6 risk of acquiring hospital-borne infections, 17 along with emotional stress 15,18 and feelings of uncertainty for both patients and caregivers (family members and friends who provide unpaid support). 15,19 ALC creates a ripple effect through the entire care pathway-starting in the emergency room, where patients may be stuck waiting for hours on stretchers in hallways (also referred to as 'hallway medicine') 20 to cancelled surgeries and compromised access to post-surgical rehabilitation and other treatments.…”

Care complexity individual factors associated with adverse events and in-hospital mortality

“…Our study also found that lack of caregiver support during hospitalization was associated with AEs. In this regard, unpaid caregivers such as family members or friends often take on an active caregiver role in hospital to mitigate the risk of functional decline, falls, and hospital-related adverse events [46]. Previous studies have shown that psychoeducational interventions aimed at caregivers reduce burden and emotional distress and enhanced caregivers' perceived social support [47].…”

Improving the Use of Healthcare Resources in Canadian Hospitals: The Impact of a Reintegration Unit in Expanding Acute Care Capacity and Resource Use in Sunnybrook Health Sciences Centre

“…Once admitted, the inability of hospitals to expeditiously transition ALC at-risk patients back to the community worsens their functional status to the point that for many patients the only possible discharge destination is ALC [12] and often requires transfer to another institutional setting. The lack of appropriate social and physical hospital services is felt to contribute to the hospitalized ALC patients' physical and mental decline [13]. Thus, dealing with the ALC challenge has important implications for patients and families as well as the healthcare system.…”