Initiatives for improving delayed discharge from a hospital setting: a scoping review

Research output: Contribution to journalArticlepeer-review

Authors

  • Lauren Cadel
  • Sara Guilcher
  • Kristina Kokorelias
  • Jason Sutherland
  • Tara Kiran
  • Kerry Kuluski

Colleges, School and Institutes

Abstract

Objective The overarching objective of the scoping review was to examine peer reviewed and grey literature for best practices that have been developed, implemented and/or evaluated for delayed discharge involving a hospital setting. Two specific objectives were to review what the delayed discharge initiatives entailed and identify gaps in the literature in order to inform future work. Design Scoping review. Methods Electronic databases and websites of government and healthcare organisations were searched for eligible articles. Articles were required to include an initiative that focused on delayed discharge, involve a hospital setting and be published between 1 January 2004 and 16 August 2019. Data were extracted using Microsoft Excel. Following extraction, a policy framework by Doern and Phidd was adapted to organise the included initiatives into categories: (1) information sharing; (2) tools and guidelines; (3) practice changes; (4) infrastructure and finance and (5) other. Results Sixty-six articles were included in this review. The majority of initiatives were categorised as practice change (n=36), followed by information sharing (n=19) and tools and guidelines (n=19). Numerous initiatives incorporated multiple categories. The majority of initiatives were implemented by multidisciplinary teams and resulted in improved outcomes such as reduced length of stay and discharge delays. However, the experiences of patients and families were rarely reported. Included initiatives also lacked important contextual information, which is essential for replicating best practices and scaling up. Conclusions This scoping review identified a number of initiatives that have been implemented to target delayed discharges. While the majority of initiatives resulted in positive outcomes, delayed discharges remain an international problem. There are significant gaps and limitations in evidence and thus, future work is warranted to develop solutions that have a sustainable impact.

Bibliographic note

Funding This work was supported by the Canadian Institutes of Health Research-Transitions in Care Strategic Funding Initiative on Best and Wise Practices (Grant #163064). KK holds the Dr Mathias Gysler Research Chair in Patient and Family Centred Care. SJTG and TK are funded by the Canadian Institutes of Health Research Embedded Scientist Salary Award on Transitions in Care working with Ontario Health (Quality); the award also supported staff to assist with screening.

Details

Original languageEnglish
Article numbere044291
JournalBMJ open
Volume11
Publication statusPublished - 11 Feb 2021

Keywords

  • health & safety, health policy, international health services, primary care, protocols & guidelines

ASJC Scopus subject areas