Table 1 Overview of studies included in the review: table organised by country, setting and year
From: Delayed discharge in inpatient psychiatric care: a systematic review
First author (year); country | Primary Aim of Study | Study Design; Data type | Setting Type | Sample (n; sample type; age) | Data Collection Method | Main findings |
|---|---|---|---|---|---|---|
Onyon (2006); England [32] | Delayed discharges | Observational Audit; Quantitative | PICU | 80 patients/88 discharge records; discharges in one year; WAA (19–61) | Retrospective audit of patient notes | Delays significantly associated with schizophrenia diagnosis (p = 0.03) and being admitted from other inpatient units or the community compared to from forensic settings (p = 0003) Black ethnicity was significantly associated with prolonged delay in discharge (p = 0.032) |
Haw (2017); England [34] | Out of area admissions | Observational Audit; Quantitative | PICU | 170 admissions/168 patients; admissions over one year; age not reported | Audit using data collection forms completed or checked by patient’s consultant psychiatrist | Wait for bed to become available, delay in identifying appropriate placement, funding dispute between trusts, delay in home area assessing patient, communication difficulties between staff and home area team, delay finding suitable placement, delay in assessment from staff from a specialist placement, patient not known to services, patient turned down by placements, and delay by Ministry of Justice. Delays significantly associated with schizophrenia diagnosis (p < 0.05) and discharge to acute ward (p < 0.0001) |
Tyrer (2006); England [31] | Measuring Bed Inventory | Observational Audit; Quantitative | Acute | 740 patients occupying 668 beds; admissions over one year; age not reported | Bed requirement inventory | No significant association with gender, age, ethnicity, marital status, or form of admission. However, those admitted from hostels or housing charity (50%) had highest levels of delayed discharge (p = 0.048) |
Commander; England [36] | Long stay | Observational Audit; Quantitative | Acute | 38 patients; all long-stay patients identified on census days; WAA (16+) | Census data, nurse reports and psychiatrist/nurse responses on Community Placement Questionnaire | Delays linked to accommodation to go to, awaiting adaptations to home, accepted for place but lacked funding, awaiting forensic assessment |
Impey (2013); England [33] | Delayed Discharges | Observational Audit; Quantitative | Acute | 65 patients; all beds in service; WAA (younger than 70) | Survey completed by inpatient team and computerised records check | Delays linked with awaiting accommodation, or awaiting transfer to other hospital More likely to be women, higher mean age. |
Cowman (2016); Ireland [27] | In-patients housing needs | Observational Audit; Quantitative | Acute | Not reported; inpatients over 12 months | Information derived from nurses | Delays linked to accommodation needs, awaiting nursing home placement |
Lewis (2006); England [28] | Delayed discharges | Mixed-methods | Mental Health trusts | 35 trusts; NHS trusts at one time-point; WAA and OA | Mixed methods survey | Delays linked to patient/family exercising choice, funding, awaiting assessment, further NHS Care, Domiciliary package, residential, nursing home |
Paton (2004); England [37] | LOS and delayed discharges | Observational Audit; Quantitative | OA | 91 occupied beds/65 patients; all beds in samples services; OA (63+) | Interview with consultant, discussion at eligibility panel, The Camberwell Assessment of Need for the Elderly (CANE); The Neuropsychiatric Inventory (NPI); The Abbreviated Bristol Activities of Daily Living Scale. | Delays linked to no alternative placement available, lack of money to finance placement, relatives refused to fund placement, relative/patient turned placement down, insufficient specialist staff resources for placement or returning home. |
Hanif (2008); England [20] | Delayed discharges | Observational Audit; Quantitative | OA | 50 patients; people discharged over 3 months; OA (61+) | Review of medical records | Delays linked to unavailable destination placement; carer delay, awaiting nursing/residential home assessment and feedback, funding issue; setup of homecare, delays in patient transfer to destination; patient out of area |
Tucker (2017); England [30] | LOS and delayed discharges | Observational Audit; Quantitative | OA | 216 admissions; patients admitted over 6 months, OA (65+) | Ward round staff reports, nursing staff collected discharge data. | Delays linked to difficulties finding suitable care home; waiting suitable care home vacancy; difficulties accessing funding for care home; waiting assessment by care home; difficulties arranging appropriate and timely community care. Significant predictors included greater cognitive impairment, being in fair-excellent health, seeing social care prior to admission. |
Poole (2014); England [35] | Delayed discharges | Observational Audit; Quantitative | Acute, PICUs, and OA | 237 inpatient beds; all in patients over three months; WAA and OA | Audit of electronic records and staff questionnaire | Delays linked to no bed available, no suitable placement found, awaiting funding decision, some patients had no right to funding, care package to support person at home not in place, waiting bed in secure facility, assessment for placement underway. Half of delayed discharge group were female, length of stay significantly longer in younger delayed adults (p = 0.014), black Caribbean patients over-represented in delayed discharges; only one patient in younger delayed discharge sample was employed. |
Chuah (2022); Australia [26] | HRDD | Qualitative | Acute | 10; HRDD; WAA | Qualitative interviews | Outcome of HRDD included lack of choice and control which reduced mental well-being; decreased physical health and created a more difficult anticipated transition back into the community. Two participants also described benefits of staying in hospital, e.g., finding it preferable to the alternative of being homeless. |
Honey (2022); Australia [24] | HRDD | Observational Audit; Quantitative | Acute | 55 HRDD and 55 non-HRDD; WAA (15–64) | Medical record review | NDIS administrative delay and rejection from rehabilitation services impacted HRDD group only. Significant predictors of HRDD: Difficulty identifying appropriate community support services, not being employed at admission, and not having a history of criminal justice system involvement. Other significant associations with HRDD were a diagnosis of schizophrenia or other psychotic disorders, physical disability/health condition, aggressive or violent behaviour, NDIS status on discharge, housing stability, legal status during admission, self-harm. |
Nguyen (2022); Australia [25] | HRDD | Mixed-methods | Acute | 59 patients; people with HRDD over one year; WAA (15–64)  + 8 staff for interviews | Medical record review and qualitative interviews with staff | Reasons for HRDD: Patient does not want to return to previous accommodation, difficulty finding accommodation, lack of housing options, lack of clear and effective pathways to find and access accommodation, awaiting property repairs or resolution of social conflicts to return to accommodation, social housing related delays, application for supported/social housing rejected, difficulty finding community support packages, request for support services rejected, lack of support network, family conflict, family does not want the patient to return to live with them, application for NDIS rejected, delays relating to funding of NDIS. Some characteristics common in HRDD sample were being male, not being employed, being unmarried, diagnosis of schizophrenia, history of violent/aggressive behaviour, drug and alcohol use. Staff also noted participation restrictions/high support needs, ongoing symptoms, and lack of insight higher in delayed group. HRDD cost $4,054,149 in 2018. |
Aflalo (2015); Canada [23] | Prolonged hospital stay | Observational Audit; Quantitative | Acute | 262 admissions; admissions with 30 days + over one year; WAA and OA (18+) | Medical record review and data collection from care team | Delays linked to difficulty finding or lack of available resources for support/placement, appropriate resources lacking or difficult to find, no longer acute but ongoing assessment to determine appropriate resources, administrative and (or) social issues (for example, waiting for a court date or waiting transfer to jail), ongoing family discussion, ongoing liaison process with community care staff, waiting for specific treatment. Most patients had a diagnosis of mental and behavioural disorders, factors influencing health status and contact with health services. Schizophrenia most prevalence mental health diagnosis. |
Little (2015); Canada [21] | Delayed discharge | Observational Audit; Quantitative | Acute | 68 hospitals; WAA and OA (18+) | Clinical Assessment data from Resident Assessment Instrument Mental health | Significant associations with being delayed included: male gender, older age, speaking foreign language, being homeless, receiving more days of contact from almost every profession the week preceding admission, being unmarried, schizophrenia diagnosis and cognitive disorders. The financial cost of caring for an ALC patient is roughly $7650. |
Little (2019); Canada [22] | Delayed discharge | Observational Audit; Quantitative | Acute | 76 and 184 patients; inpatient admissions over two years; WAA and OA | Clinical Assessment data from Resident Assessment Instrument Mental health and Wait Time Information System | Variables associated with higher odds of delay were impairment in activities of daily living, moderate to severe cognitive impairment, no insight into mental health, disorders of childhood/adolescence, intellectual disabilities, impairment in Activities of Daily Living, aggressive behaviours, history of substance abuse, having six or more previous admissions, being middle and older age, male, speaking a primary language other than English or French, being visited less often by a social relation, social isolation and not being married. Clinical variables that had lower odds of 30 + day delay were psychosis/schizophrenia, severe symptoms related to social withdrawal, and moderate-to-severe symptoms of depression. |
Berg (2005); Norway [29] | Bed occupancy | Observational Audit; Quantitative | Acute | 23 patients; identified on a random day; WAA (22–56) | Method of data collection unclear | Delays linked to waiting for secondary resident treatment. In the delayed group there were more men, mean age was lower, all had a psychotic illness. Delays accounted for 54.8% of cost of treatment. |