Defining discharge-readiness from subacute care from all stakeholders’ perspectives: a systematic review

Abstract

Purpose

Research to date has focused on clinicians’ views on patients’ discharge readiness from acute hospital settings.This study aims to synthesise the literature on discharge readiness from sub-acute (rehabilitation) hospital settings from all stakeholders’ perspectives.

Methods

Electronic databases (MEDLINE, CINAHL, Ageline, AMED and Global Health) were systematically searched for post-2000 publications on discharge readiness of adult inpatients in sub-acute settings. After screening, quantitative and qualitative studies were assessed for bias using the Downs and Black checklist and McMaster critical assessment tool respectively, and narrative analysis conducted.

Results

From the 3516 papers identified, 23 were included in the review. Overall quality of articles was rated as adequate. Narrative synthesis identified three main themes: the importance of functional outcomes; confounding factors impact on discharge destination and length of stay and barriers and facilitators to discharge.

Conclusion

Despite limited literature defining sub-acute patients’ discharge-readiness from all stakeholders’ perspectives, synthesis of available findings identified major themes for consideration when determining when a patient is ready to leave hospital. Limitations include the heterogeneity of the studies located impacted on data extraction and quality appraisal.

IMPLICATIONS FOR REHABILITATION

• Discharging patients from hospital is complex, discharge too early may lead to poor medical outcomes or readmission, while discharge too late may increase the risk of hospital-based adverse events.

• Multiple factors need to be considered when considering the discharge readiness of an inpatient.

• Ensuring adequate social support is key to maximising transition from hospital to home.

• Combining the use of functional outcome measures with clinical decision-making allows for quantifying readiness for discharge.

Keywords:

• Subacute care
• patient discharge
• length of stay
• occupational therapy

Disclosure statement

No potential conflict of interest was reported by the author(s).