NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK.
Institute of Education EPPI-Centre, University College London, London, UK.
Health Expect. 2018 Feb;21(1):41-56. doi: 10.1111/hex.12619. Epub 2017 Sep 12.
The impact of delayed discharge on patients, health-care staff and hospital costs has been incompletely characterized.
To systematically review experiences of delay from the perspectives of patients, health professionals and hospitals, and its impact on patients' outcomes and costs.
Four of the main biomedical databases were searched for the period 2000-2016 (February). Quantitative, qualitative and health economic studies conducted in OECD countries were included.
Thirty-seven papers reporting data on 35 studies were identified: 10 quantitative, 8 qualitative and 19 exploring costs. Seven of ten quantitative studies were at moderate/low methodological quality; 6 qualitative studies were deemed reliable; and the 19 studies on costs were of moderate quality. Delayed discharge was associated with mortality, infections, depression, reductions in patients' mobility and their daily activities. The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care and well-being. Extra bed-days could account for up to 30.7% of total costs and cause cancellations of elective operations, treatment delay and repercussions for subsequent services, especially for elderly patients.
The poor quality of the majority of the research means that implications for practice should be cautiously made. However, the results suggest that the adverse effects of delayed discharge are both direct (through increased opportunities for patients to acquire avoidable ill health) and indirect, secondary to the pressures placed on staff. These findings provide impetus to take a more holistic perspective to addressing delayed discharge.
延迟出院对患者、医护人员和医院成本的影响尚未得到充分描述。
系统回顾患者、卫生专业人员和医院对延迟出院的体验，及其对患者结局和成本的影响。
在 2000 年至 2016 年（2 月）期间，检索了 4 个主要的生物医学数据库。纳入经合组织国家开展的定量、定性和卫生经济学研究。
共确定了 37 篇报告了 35 项研究数据的论文：10 项定量研究、8 项定性研究和 19 项研究费用。十分之七的定量研究被认为具有中等/低方法学质量；6 项定性研究被认为是可靠的；19 项关于费用的研究质量中等。延迟出院与死亡率、感染、抑郁、患者活动能力和日常活动减少有关。定性研究强调了减少工作人员压力和减少跨专业关系延迟出院的压力，对患者护理和幸福感产生影响。额外的住院天数可能占总费用的 30.7%，导致择期手术取消、治疗延迟以及对后续服务的影响，特别是对老年患者。
大多数研究的质量较差，因此应该谨慎地对实践产生的影响做出结论。然而，研究结果表明，延迟出院的不良后果是直接的（通过增加患者获得可避免的健康问题的机会）和间接的，这是由于对工作人员的压力造成的。这些发现为采取更全面的方法来解决延迟出院问题提供了动力。
