Factors affecting discharges on medical wards: a project conducted by surveying senior nursing staff members
Introduction: As the population and emergency department (ED) visits increase, the shortage of bed availability is a major concern. Factors, such as increasing population growth, inefficiencies in discharge planning (including the inability to place patients in appropriate post-acute care facilities...
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Elsevier
2025-06-01
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| Series: | Future Healthcare Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2514664525001791 |
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| author | Mehak Gupta Handi Y Salim George Varughese |
| author_facet | Mehak Gupta Handi Y Salim George Varughese |
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| description | Introduction: As the population and emergency department (ED) visits increase, the shortage of bed availability is a major concern. Factors, such as increasing population growth, inefficiencies in discharge planning (including the inability to place patients in appropriate post-acute care facilities), outdated discharge planning tools, bed turnaround and staffing shortages increase the demand for hospital beds.1 This creates numerous issues, including decreased access to care, longer wait times, decreased patient and staff satisfaction, and diminished hospital revenue.2Currently, our hospital has reported several critical incidents due to winter pressures. Admission delays create a potential safety hazard for patients and a likely financial hazard to the hospital. Much focus is on the ED, but capacity problems also exist in other areas of hospitals. Therefore, a survey was carried out within the general medical wards of a large tertiary centre to identify any common factors leading to delayed discharge. Methods: A questionnaire was developed after discussion with discharge facilitators and ward managers to identify common themes for delayed discharges. Personal interviews were conducted with ward managers or nurses in charge of eight general medical wards and information was collected via the questionnaire. Results: Some of the common problems identified were as follows: social aspects, diagnostic or procedural delays, specialty input delays, medical complexity of patients, delay in ‘to take out’(TTO) medications and discharge summaries, and personnel-related issues (Fig 1).All the staff members interviewed reported delays in discharge secondary to medical complexity and social issues. Social issues could pertain to lack of community hospital beds, gap in care home/rehab assessments, and lack of placement spaces, care packages and homelessness. Timely specialist input was another challenge that everyone had noticed and involved both medical and surgical specialties. 88% reported delays in discharge letters and TTOs being processed as well as in diagnostics, such as endoscopy, specialist blood tests and echocardiography. Approximately 60% noted variation in senior decision-making. Only three out of eight wards reported delays due to procedures such as PEG.When asked about how to improve this process, we received variable responses, such as more community hospital beds, increasing capacity in virtual wards, preparation of discharge summaries in advance, improved communication between staff members, proactive planning and specialties to review in a timely manner. Conclusions: Several factors, such as medical complexity, social issues, diagnostic or procedural delays, specialist input delays and personnel-related issues, were attributed to late discharges in our medical wards. Our recommendations would be to dedicate staff to complete discharge summaries, speedier specialist input and increasing capacity of virtual wards. Models, such as Discharge to Assess’ (D2A), which prioritises conducting assessments for long-term care and support needs in the most appropriate time and one best suited to the individual, as well as criteria-led discharge to expedite discharges over the weekends, should also be considered.3-4 |
| format | Article |
| id | doaj-art-227decc8a30643cb97d86bf335b235f1 |
| institution | DOAJ |
| issn | 2514-6645 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Future Healthcare Journal |
| spelling | doaj-art-227decc8a30643cb97d86bf335b235f12025-08-20T02:47:17ZengElsevierFuture Healthcare Journal2514-66452025-06-0112210040010.1016/j.fhj.2025.100400Factors affecting discharges on medical wards: a project conducted by surveying senior nursing staff membersMehak Gupta0Handi Y Salim1George Varughese2University Hospital North MidlandsUniversity Hospital North MidlandsUniversity Hospital North MidlandsIntroduction: As the population and emergency department (ED) visits increase, the shortage of bed availability is a major concern. Factors, such as increasing population growth, inefficiencies in discharge planning (including the inability to place patients in appropriate post-acute care facilities), outdated discharge planning tools, bed turnaround and staffing shortages increase the demand for hospital beds.1 This creates numerous issues, including decreased access to care, longer wait times, decreased patient and staff satisfaction, and diminished hospital revenue.2Currently, our hospital has reported several critical incidents due to winter pressures. Admission delays create a potential safety hazard for patients and a likely financial hazard to the hospital. Much focus is on the ED, but capacity problems also exist in other areas of hospitals. Therefore, a survey was carried out within the general medical wards of a large tertiary centre to identify any common factors leading to delayed discharge. Methods: A questionnaire was developed after discussion with discharge facilitators and ward managers to identify common themes for delayed discharges. Personal interviews were conducted with ward managers or nurses in charge of eight general medical wards and information was collected via the questionnaire. Results: Some of the common problems identified were as follows: social aspects, diagnostic or procedural delays, specialty input delays, medical complexity of patients, delay in ‘to take out’(TTO) medications and discharge summaries, and personnel-related issues (Fig 1).All the staff members interviewed reported delays in discharge secondary to medical complexity and social issues. Social issues could pertain to lack of community hospital beds, gap in care home/rehab assessments, and lack of placement spaces, care packages and homelessness. Timely specialist input was another challenge that everyone had noticed and involved both medical and surgical specialties. 88% reported delays in discharge letters and TTOs being processed as well as in diagnostics, such as endoscopy, specialist blood tests and echocardiography. Approximately 60% noted variation in senior decision-making. Only three out of eight wards reported delays due to procedures such as PEG.When asked about how to improve this process, we received variable responses, such as more community hospital beds, increasing capacity in virtual wards, preparation of discharge summaries in advance, improved communication between staff members, proactive planning and specialties to review in a timely manner. Conclusions: Several factors, such as medical complexity, social issues, diagnostic or procedural delays, specialist input delays and personnel-related issues, were attributed to late discharges in our medical wards. Our recommendations would be to dedicate staff to complete discharge summaries, speedier specialist input and increasing capacity of virtual wards. Models, such as Discharge to Assess’ (D2A), which prioritises conducting assessments for long-term care and support needs in the most appropriate time and one best suited to the individual, as well as criteria-led discharge to expedite discharges over the weekends, should also be considered.3-4http://www.sciencedirect.com/science/article/pii/S2514664525001791 |
| spellingShingle | Mehak Gupta Handi Y Salim George Varughese Factors affecting discharges on medical wards: a project conducted by surveying senior nursing staff members Future Healthcare Journal |
| title | Factors affecting discharges on medical wards: a project conducted by surveying senior nursing staff members |
| title_full | Factors affecting discharges on medical wards: a project conducted by surveying senior nursing staff members |
| title_fullStr | Factors affecting discharges on medical wards: a project conducted by surveying senior nursing staff members |
| title_full_unstemmed | Factors affecting discharges on medical wards: a project conducted by surveying senior nursing staff members |
| title_short | Factors affecting discharges on medical wards: a project conducted by surveying senior nursing staff members |
| title_sort | factors affecting discharges on medical wards a project conducted by surveying senior nursing staff members |
| url | http://www.sciencedirect.com/science/article/pii/S2514664525001791 |
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