Assessment tools and factors used to predict discharge from acute general medical wards: a systematic review

Abstract

Purpose

To identify assessment tools and patient factors statistically associated with discharge destination in general medical inpatients.

Materials and method

A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Four electronic databases were searched. Studies were eligible if they were a quantitative study design, had adult acute general medical inpatients and published in English. Outcomes of interest were tools or factors with statistical correlations with discharge destination (home, subacute or residential care). Articles were screened by two independent assessors. Data were extracted by one reviewer and independently checked by a second reviewer. Data were analysed/described descriptively.

Results

Twenty-three studies were included. Twenty-three tools and 44 factors were identified, which spanned Health Condition, Body Structure and Function, Activity, Participation, Environment and Personal concepts of the World Health Organisation International Classification of Function, Disability and Health (WHO ICF).

Conclusions

The large number of tools and factors found and their distribution across several WHO ICF concepts exemplifies the complexities of predicting discharge. No single assessment tool that best predicts discharge destination was identified, but rather there were a variety of potential tools identified. Further research is needed to determine the psychometric properties of the identified assessment tools as well as additional predictors of subacute care (including rehabilitation). This is important as it may allow for timely clinical decision making.

Trial Registration

A priori, PROSPERO (CRD42017064209).

IMPLICATIONS FOR REHABILITATION

• This systematic review identified a large number of assessment tools and patient factors associated with discharge destination (home, subacute and residential care) in general medical inpatients.

• All of the domains of the WHO ICF framework are associated with discharge destination and must be considered.

• Clinicians in the acute setting can use these findings to assist selection of assessment tools to identify patients likely to need rehabilitation or subacute care.

• Early identification of patients who are unable to return to their place of residence is essential as it allows for provision of early rehabilitation and subsequent discharge planning.

Keywords:

• Patient discharge
• clinical decision-making
• psychometrics
• inpatients
• humans
• adults
• subacute care

Acknowledgements

The authors thank the physiotherapy department of the Royal Melbourne Hospital for their support.

Disclosure statement

Several of the authors of this systematic review were also authors on one of the studies included in this paper (“Factors associated with discharge in community-dwelling adults admitted to Acute General Medical units”). The two authors of this systematic review who were not involved in the included study (Nina Leggett and Melanie Tomkins) were responsible for screening, data extraction and data checking for this review.