Expanding our understanding of factors impacting delayed hospital discharge: Insights from patients, caregivers, providers and organizational leaders in Ontario, Canada

• Published in: Health policy (Amsterdam) 2022-04, Vol.126 (4), p.310-317
• Main Authors: Kuluski, Kerry, Cadel, Lauren, Marcinow, Michelle, Sandercock, Jane, Guilcher, Sara JT
• Format: Article
• Language: English
• Subjects: Adult; Adults; Aging; Burnout; Caregivers; Delayed; Delayed discharge; Health policy; Hospitals; Humans; Imbalance; Infrastructure; Older people; Ontario; Patient Discharge; Patients; Policy implementation; Qualitative Research; Responsibility; Rules; Rural Population
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2022.02.001

•Delayed discharge is a care quality issue impacting health systems worldwide•Despite delayed discharge being a long-standing issue in hospitals, the problem persists•We unpack causes, policies and preferences impacting delayed discharge using a framework•Cross-sectoral collaboration and strengthening of relationships among stakeholders is required The purpose of this paper was to understand the nature of delayed hospital discharge through the lens of a policy framework (ideas, institutions and interests; 3-I framework). One-to-one in-depth interviews were conducted with 57 participants, including 18 patients, 18 caregivers, 11 providers and 10 organizational leaders across two hospital networks in urban and rural regions of Ontario, Canada. Delayed discharge was a product of spill-over effects (due to rules and eligibility in other health sectors) and variable implementation of policies and guidelines (institutions); competing priorities and tensions among patients, caregivers, providers and organizational leaders (interests); as well as a number of perceived root causes including patient complexity, caregiver burnout, lack of system infrastructure, and an imbalance of system and personal responsibility to support aging adults (ideas). The 3-I framework allowed us to examine the contributing factors to delayed discharge in a comprehensive way. Based on our findings we suggest that cross-sectoral collaboration and strengthening of relationships among stakeholders is required to address this complex policy problem.