Background Effective discharge planning is vital for palliative care patients so they can be cared for, and ultimately die, in their preferred location. Delayed discharges can result in ineffective use of resources and cause distress to patients. This audit looked into causes of delayed discharge from a specialist palliative care unit, and examined ways to improve the discharge process to ameliorate these factors.
Methods Notes from the first 26 admissions to a specialist palliative care unit from 1 January 2011 were examined. Incomplete or missing notes were excluded, as were admissions for end of life care. Information recorded included patient demographics, reason for admission, discharge destination, proposed and actual date of discharge, and reasons for any delay.
Results 44% of patients' discharges were delayed 3–57 days, leading to 164 extra bed days, with an average of 10 days delay per admission. Three patients were delayed due to medical causes; each of these had multiple reasons for their delay. Four of the five patients delayed for non-medical reasons were held-up by delayed package of care (POC) provision; late referral to social services was implicated in 75%. Men are 2.1 more times likely to be delayed than women and patients over 75 years of age are 2.1 times more likely to be delayed.
Conclusion Causes for delayed discharge are varied and complex. Improvements in POC provision would reduce this major cause of delay. Discharge planning should begin early, with adequate information for patients to be able to make an informed decision. Increased efficiency in the multi-disciplinary team would increase the effectiveness of the discharge process. Identification of certain higher risk demographics should help to focus improvements in the discharge process. This audit has identified important trends, which, if improved, may save resources and improve patient satisfaction.
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