Effective discharge planning – timely assignment of an estimated date of discharge
Lixin Ou A B , Jack Chen A , Lis Young A , Nancy Santiano A , La-Stacey Baramy A and Ken Hillman AA Simpson Centre for Health Services Research, The University of New South Wales, Locked Bag 7103, Liverpool BC, NSW 1871, Australia. Email: jackchen@unsw.edu.au; lis.young@sswahs.nsw.gov.au; nancy.santiano@sswahs.nsw.gov.au; la-stacey.baramy@sswahs.nsw.gov.au; ken.hillman@sswahs.nsw.gov.au
B Corresponding author. Email: lixin.ou@unsw.edu.au
Australian Health Review 35(3) 357-363 https://doi.org/10.1071/AH09843
Submitted: 13 October 2009 Accepted: 7 November 2010 Published: 25 August 2011
Abstract
Objective. To examine the implementation of estimated date of discharge (EDD) for planned admissions and admissions via the emergency department, to assess the variance between EDD and the actual date of discharge (ADD), and to explore the determinants of delayed discharge in a tertiary referral centre, Sydney, Australia.
Methods. Primary data from a convenience sample of 1958 admissions for allocation of EDDs were linked with administrative data. The window for assigning EDDs for planned admissions was 24 h, for admissions via the emergency department it was 48 h. Logistic regression models were used to examine the key factors associated with an EDD being assigned within 24 h or 48 h of an admission. An ordinal logistic regression model was used to explore the determinants of delayed discharge.
Results. Only 13.4% of planned admissions and 27.5% of admissions via the emergency department were allocated a timely EDD. Older patients, patients with significant burdens of chronic morbidity (OR = 0.903; P = 0.011); and patients from a non-English-speaking background (OR = 0.711; P = 0.059) were less likely to be assigned a timely EDD. The current Charlson Index score was a significant predictor of a positive variance between EDD and ADD.
Conclusions. The prevalence of the timely assignment of an EDD was low and was lowest for planned admissions. The current Charlson Index score is an effective tool for identifying patients who are more likely to experience delayed discharge.
What is known about the topic? Failure to assign an EDD is one of the major barriers to implementing effective discharge. Establishing an EDD for a patient within 24 h of an admission is thought to be a measure of efficient and high quality discharge planning.
What does this paper add? Older patients, patients with significant burdens of chronic morbidity, and patients from a non-English-speaking background were less likely to be assigned a timely EDD. The current Charlson Index score was a significant predictor of a positive variance between EDD and ADD.
What are the implications for practitioners? A significant gap existed between policy and the implementation of assigning EDD in a large sample of discharges. Effective discharge planning may be obstructed by failure to assign an EDD at the time of admission.
Additional keywords: admission, length of stay, elderly.
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