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Barriers to timely discharge from the general medicine service at an academic teaching hospital
  1. Meera V Ragavan,
  2. David Svec,
  3. Lisa Shieh
  1. Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Meera V Ragavan, Department of Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA; mragavan{at}stanford.edu

Abstract

Background Reducing delays for patients who are safe to be discharged is important for minimising complications, managing costs and improving quality. Barriers to discharge include placement, multispecialty coordination of care and ineffective communication. There are a few recent studies that describe barriers from the perspective of all members of the multidisciplinary team.

Study objective To identify the barriers to discharge for patients from our medicine service who had a discharge delay of over 24 hours.

Methodology We developed and implemented a biweekly survey that was reviewed with attending physicians on each of the five medicine services to identify patients with an unnecessary delay. Separately, we conducted interviews with staff members involved in the discharge process to identify common barriers they observed on the wards.

Results Over the study period from 28 October to 22 November 2013, out of 259 total discharges, 87 patients had a delay of over 24 hours (33.6%) and experienced a total of 181 barriers. The top barriers from the survey included patient readiness, prolonged wait times for procedures or results, consult recommendations and facility placement. A total of 20 interviews were conducted, from which the top barriers included communication both between staff members and with the patient, timely notification of discharge and lack of discharge standardisation.

Conclusions There are a number of frequent barriers to discharge encountered in our hospital that may be avoidable with planning, effective communication methods, more timely preparation and tools to standardise the discharge process.

  • discharge planning
  • HEALTH SERVICES ADMINISTRATION & MANAGEMENT
  • INTERNAL MEDICINE

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Footnotes

  • Contributors Study concept and design: MVR, DS, LS. Data collection: MVR. Data analysis and interpretation: MVR. Drafting of the manuscript: MVR, DS and LS. Study supervision: DS and LS.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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