Impact of accurate initial discharge planning and inpatient transfers of care on discharge delays: a retrospective cohort study

Abstract

Objective: to investigate the association between initial discharge planning and transfers of inpatient care with discharge delay. To identify operational changes which could expedite discharge within the Discharge to Assess (D2A) model.

Design: retrospective cohort study.

Setting: University Hospital Southampton National Health Service Foundation Trust (UHS).

Participants: all adults (≥18 years) who registered a hospital inpatient stay in UHS between 1 January 2021 and 31 December 2022 (n=258 051). After excluding inpatient stays without complete discharge planning data or key demographic/clinical information, 65 491 inpatient stays were included in the final analysis. Data included demographics, comorbidities, ward movements, care team handovers and discharge planning records.

Primary and secondary outcome measures: the primary outcome was discharge delay, defined as the number of days between the final estimated discharge date and the actual discharge date. For the purposes of OR analysis, discharge delay was modelled as a binary outcome: any delay (>0 days) versus no delay. Logistic regression models were used to examine associations between initial discharge planning accuracy, the number of ward moves and the number of in-specialty handovers and the likelihood of discharge delay, adjusting for demographic and patient complexity factors.

Results: out of 65 491 inpatient stays, 10 619 had an initial planned discharge pathway that was different from the final discharge pathway. 7790 of these inpatient stays (75.1%) recorded a discharge delay. In contrast, among the 54 872 inpatient stays where the initial and final pathway matched, 10 216 (18.6%) recorded a delay. Using logistic regression modelling a binary outcome (any discharge delay vs no delay), an inaccurate initial pathway was associated with significantly increased odds of delay (adjusted OR (aOR) 2.72, 95% CI 2.55 to 2.91). Each additional ward move (aOR 1.25, 95% CI 1.23 to 1.28) and each in-specialty handover (aOR 1.17, 95% CI 1.14 to 1.20) were also associated with higher odds of discharge delay.

Conclusions: this study finds a strong association between inaccurate initial discharge plans and inpatient transfers of care with discharge delay, after controlling for patient complexity and acuity. This highlights the need to consider how initial plans and inpatient transfers affect discharge planning. Given the lead times for organising onward care, operational inefficiencies are most impactful for patients eventually discharged on pathways with higher planning complexity.

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Identifiers

ORCID for Dan Burns: orcid.org/0000-0001-6976-1068

ORCID for Chris Duckworth: orcid.org/0000-0003-0659-2177

ORCID for Carlos Lamas Fernandez: orcid.org/0000-0001-5329-7619

ORCID for Michael Boniface: orcid.org/0000-0002-9281-6095

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