Causes of delayed hospital discharge among adult clients: a scoping review

A scoping review was conducted. We searched in the Ebscohost’ plataform, in PubMed, and in grey literature, consulting the bibliographic references of the documents found.

RESULTS

From the 22 articles analyzed it was verified that the delay in hospital discharge is due to causes related to community resources, namely the lack of vacancies in health units, and social reasons; to organizational causes related to health care; to individual causes, standing out family and financial issues; culminating in organizational causes related to hospital management.

CONCLUSION

The delay in hospital discharge is multifactorial. It’s necessary to monitor the hospitalization process, focusing on early discharge planning.

KEYWORDS:
Patient discharge; Nursing care; Length of stay

Causes	Cause subtype
Organizational Related to healthcare	Waiting for health evaluations, treatment, or exam results⁴4. Majeed UM, Williams DT, Pollock R, Amir F, Liam M, Foong KS, et al. Delay in discharge and its impact on unnecessary hospital bed occupancy. BMC Health Serv Res. 2012 [cited 2017 Aug 4];12:410. doi: https://doi.org/10.1186/1472-6963-12-410. https://doi.org/10.1186/1472-6963-12-410... ^,⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^-¹⁵15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... ^,¹⁷17. García FS, Oterino de la Fuente D, Peiró S, Librero J, Raya CB, García de León NP, et al. Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años. Rev Esp Salud Publica. 2001 [cited 2017 Aug 5];75(3):237-48. Available from: http://scielo.isciii.es/pdf/resp/v75n3/a07v75n3.pdf. http://scielo.isciii.es/pdf/resp/v75n3/a... ^-¹⁸18. Benson RT, Drew JC, Galland RB. A waiting list to go home: an analysis of delayed discharges from surgical beds. Ann R Coll Surg Engl. 2006;88(7):650-2. doi: https://doi.org/10.1308/003588406X149246. https://doi.org/10.1308/003588406X149246... ^,²²22. Jasinarachchi KH, Ibrahim IR, Keegan BC, Mathialagan R, McGourty JC, Phillips JRN, et al. Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over. BMC Geriatrics. 2009;9:4. doi: https://doi.org/10.1186/1471-2318-9-4. https://doi.org/10.1186/1471-2318-9-4...
	Falls¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-...
	Pain management¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-...
	Care during intra-hospital rehabilitation¹⁰10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983... ^,²⁴24. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011;82(6):679-84. doi: https://doi.org/10.3109/17453674.2011.636682. https://doi.org/10.3109/17453674.2011.63...
	Number of procedures undergone²2. Holmås TH, Islam MK, Kjerstad E. Between two beds: inappropriately delayed discharges from hospitals. Int J Health Care Finance Econ. 2013 [cited 2017 Aug 5];13(3-4):201-17. doi: https://doi.org/10.1007/s10754-013-9135-4. https://doi.org/10.1007/s10754-013-9135-...
	Need for bladder catheterization²⁴24. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011;82(6):679-84. doi: https://doi.org/10.3109/17453674.2011.636682. https://doi.org/10.3109/17453674.2011.63... ^-²⁵25. Panteli M, Habeeb S, McRoberts J, Porteous MJ. Enhanced care for primary hip arthroplasty factors affecting length of hospital stay. Eur J Orthop Surg Traumatol. 2014;24(3):353-8. doi: https://doi.org/10.1007/s00590-013-1188-z. https://doi.org/10.1007/s00590-013-1188-...
	Need for blood transfusions²⁰20. Reddy KM, Meyer CE, Palazzo FF, Conaghan P, Blunt MC, Stebbings WS, et al. Postoperative stay following colorectal surgery: a study of factors associated with prolonged hospital stay. Ann R Coll Surg Engl. 2003;85(2):111-4. doi: https://doi.org/10.1308/003588403321219894. https://doi.org/10.1308/0035884033212198... ^,²⁴24. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011;82(6):679-84. doi: https://doi.org/10.3109/17453674.2011.636682. https://doi.org/10.3109/17453674.2011.63... ^-²⁵25. Panteli M, Habeeb S, McRoberts J, Porteous MJ. Enhanced care for primary hip arthroplasty factors affecting length of hospital stay. Eur J Orthop Surg Traumatol. 2014;24(3):353-8. doi: https://doi.org/10.1007/s00590-013-1188-z. https://doi.org/10.1007/s00590-013-1188-...
	Use of patient-controlled analgesia²⁵25. Panteli M, Habeeb S, McRoberts J, Porteous MJ. Enhanced care for primary hip arthroplasty factors affecting length of hospital stay. Eur J Orthop Surg Traumatol. 2014;24(3):353-8. doi: https://doi.org/10.1007/s00590-013-1188-z. https://doi.org/10.1007/s00590-013-1188-...
	Discharge preparation⁴4. Majeed UM, Williams DT, Pollock R, Amir F, Liam M, Foong KS, et al. Delay in discharge and its impact on unnecessary hospital bed occupancy. BMC Health Serv Res. 2012 [cited 2017 Aug 4];12:410. doi: https://doi.org/10.1186/1472-6963-12-410. https://doi.org/10.1186/1472-6963-12-410...
	Nurse referral³3. Rambani R, Okafor B. Evaluation of factors delaying discharge in acute orthopedic wards: a prospective study. Eur J Trauma Emerg Surg. 2008 [cited 2017 Aug 3];34(1):24-8. doi: https://doi.org/10.1007/s00068-007-6184-8. https://doi.org/10.1007/s00068-007-6184-... ^,⁹9. Hendy P, Patel JH, Kordbacheh T, Laskar N, Harbord M. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med [Lond]. 2012;12(4):320-3. doi: https://doi.org/10.7861/clinmedicine.12-4-320. https://doi.org/10.7861/clinmedicine.12-...
	Professional team mistakes⁴4. Majeed UM, Williams DT, Pollock R, Amir F, Liam M, Foong KS, et al. Delay in discharge and its impact on unnecessary hospital bed occupancy. BMC Health Serv Res. 2012 [cited 2017 Aug 4];12:410. doi: https://doi.org/10.1186/1472-6963-12-410. https://doi.org/10.1186/1472-6963-12-410... ^,¹⁵15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... ^,¹⁷17. García FS, Oterino de la Fuente D, Peiró S, Librero J, Raya CB, García de León NP, et al. Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años. Rev Esp Salud Publica. 2001 [cited 2017 Aug 5];75(3):237-48. Available from: http://scielo.isciii.es/pdf/resp/v75n3/a07v75n3.pdf. http://scielo.isciii.es/pdf/resp/v75n3/a...
	Healthcare-related infection ³3. Rambani R, Okafor B. Evaluation of factors delaying discharge in acute orthopedic wards: a prospective study. Eur J Trauma Emerg Surg. 2008 [cited 2017 Aug 3];34(1):24-8. doi: https://doi.org/10.1007/s00068-007-6184-8. https://doi.org/10.1007/s00068-007-6184-... ^,¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-... ^-²⁰20. Reddy KM, Meyer CE, Palazzo FF, Conaghan P, Blunt MC, Stebbings WS, et al. Postoperative stay following colorectal surgery: a study of factors associated with prolonged hospital stay. Ann R Coll Surg Engl. 2003;85(2):111-4. doi: https://doi.org/10.1308/003588403321219894. https://doi.org/10.1308/0035884033212198...
Organizational Hospital Management	Lack of human resources⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^-¹⁵15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... ^,²³23. Varnava AM, Sedgwick JEC, Deaner A, Ranjadayalan K, Timmis AD. Restricted weekend service inappropriately delays discharge after acute myocardial infarction. Heart. 2002 [cited 2017 Aug 5];87(3):216-9. Available from: https://heart.bmj.com/content/heartjnl/87/3/216.full.pdf. https://heart.bmj.com/content/heartjnl/8...
	Hospitalization in one or more medical fields¹⁰10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983...
	Admission day¹⁵15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... ^,²³23. Varnava AM, Sedgwick JEC, Deaner A, Ranjadayalan K, Timmis AD. Restricted weekend service inappropriately delays discharge after acute myocardial infarction. Heart. 2002 [cited 2017 Aug 5];87(3):216-9. Available from: https://heart.bmj.com/content/heartjnl/87/3/216.full.pdf. https://heart.bmj.com/content/heartjnl/8...
	Social worker actions⁹9. Hendy P, Patel JH, Kordbacheh T, Laskar N, Harbord M. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med [Lond]. 2012;12(4):320-3. doi: https://doi.org/10.7861/clinmedicine.12-4-320. https://doi.org/10.7861/clinmedicine.12-...
Personal / Individual	Associated pathology²2. Holmås TH, Islam MK, Kjerstad E. Between two beds: inappropriately delayed discharges from hospitals. Int J Health Care Finance Econ. 2013 [cited 2017 Aug 5];13(3-4):201-17. doi: https://doi.org/10.1007/s10754-013-9135-4. https://doi.org/10.1007/s10754-013-9135-... ^,¹⁰10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983... ^,¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-...
	Increase in the dependency level¹⁰10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983... ^,¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-...
	Family issues⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^-⁸8. Lenzi J, Mongardi M, Rucci P, Di Ruscio E, Vizioli M, Randazzo C, et al. Sociodemographic, clinical and organizational factors associated with delayed hospital discharges: a cross-sectional study. BMC Health Serv Res. 2014;14:128. doi: https://doi.org/10.1186/1472-6963-14-128. https://doi.org/10.1186/1472-6963-14-128... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^-¹⁵15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... ^,¹⁷17. García FS, Oterino de la Fuente D, Peiró S, Librero J, Raya CB, García de León NP, et al. Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años. Rev Esp Salud Publica. 2001 [cited 2017 Aug 5];75(3):237-48. Available from: http://scielo.isciii.es/pdf/resp/v75n3/a07v75n3.pdf. http://scielo.isciii.es/pdf/resp/v75n3/a... ^,²¹21. Giraldo DM, Navarro A, Quijano AS, Villegas A, Marchante RA, Otero EL. Retraso del alta hospitalaria por motivos no medicos. Rev Clin Espanola. 2012;212(5):229-34. doi: https://doi.org/10.1016/j.rce.2011.12.009. https://doi.org/10.1016/j.rce.2011.12.00...
	Financial issues⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^,¹⁶16. Worthington AD, Oldham JB. Delayed discharge from rehabilitation after brain injury. Clin Rehabil. 2006;20(1):79-82. doi: https://doi.org/10.1191/0269215506cr881oa. https://doi.org/10.1191/0269215506cr881o...
Community	Social issues³3. Rambani R, Okafor B. Evaluation of factors delaying discharge in acute orthopedic wards: a prospective study. Eur J Trauma Emerg Surg. 2008 [cited 2017 Aug 3];34(1):24-8. doi: https://doi.org/10.1007/s00068-007-6184-8. https://doi.org/10.1007/s00068-007-6184-... ^,⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,⁹9. Hendy P, Patel JH, Kordbacheh T, Laskar N, Harbord M. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med [Lond]. 2012;12(4):320-3. doi: https://doi.org/10.7861/clinmedicine.12-4-320. https://doi.org/10.7861/clinmedicine.12-... ^,¹²12. Landeiro F, Leal J, Gray AM. The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs. Osteoporos Int. 2015;27(2):737-45. doi: https://doi.org/10.1007/s00198-015-3293-9. https://doi.org/10.1007/s00198-015-3293-... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^,¹⁷17. García FS, Oterino de la Fuente D, Peiró S, Librero J, Raya CB, García de León NP, et al. Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años. Rev Esp Salud Publica. 2001 [cited 2017 Aug 5];75(3):237-48. Available from: http://scielo.isciii.es/pdf/resp/v75n3/a07v75n3.pdf. http://scielo.isciii.es/pdf/resp/v75n3/a... ^,¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-... 20. Reddy KM, Meyer CE, Palazzo FF, Conaghan P, Blunt MC, Stebbings WS, et al. Postoperative stay following colorectal surgery: a study of factors associated with prolonged hospital stay. Ann R Coll Surg Engl. 2003;85(2):111-4. doi: https://doi.org/10.1308/003588403321219894. https://doi.org/10.1308/0035884033212198... ^-²¹21. Giraldo DM, Navarro A, Quijano AS, Villegas A, Marchante RA, Otero EL. Retraso del alta hospitalaria por motivos no medicos. Rev Clin Espanola. 2012;212(5):229-34. doi: https://doi.org/10.1016/j.rce.2011.12.009. https://doi.org/10.1016/j.rce.2011.12.00...
	No vacancy in retirement homes and healthcare units²2. Holmås TH, Islam MK, Kjerstad E. Between two beds: inappropriately delayed discharges from hospitals. Int J Health Care Finance Econ. 2013 [cited 2017 Aug 5];13(3-4):201-17. doi: https://doi.org/10.1007/s10754-013-9135-4. https://doi.org/10.1007/s10754-013-9135-... ^,³3. Rambani R, Okafor B. Evaluation of factors delaying discharge in acute orthopedic wards: a prospective study. Eur J Trauma Emerg Surg. 2008 [cited 2017 Aug 3];34(1):24-8. doi: https://doi.org/10.1007/s00068-007-6184-8. https://doi.org/10.1007/s00068-007-6184-... ^,⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,⁸8. Lenzi J, Mongardi M, Rucci P, Di Ruscio E, Vizioli M, Randazzo C, et al. Sociodemographic, clinical and organizational factors associated with delayed hospital discharges: a cross-sectional study. BMC Health Serv Res. 2014;14:128. doi: https://doi.org/10.1186/1472-6963-14-128. https://doi.org/10.1186/1472-6963-14-128... 9. Hendy P, Patel JH, Kordbacheh T, Laskar N, Harbord M. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med [Lond]. 2012;12(4):320-3. doi: https://doi.org/10.7861/clinmedicine.12-4-320. https://doi.org/10.7861/clinmedicine.12-... 10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983... 11. Houghton JS, Rodriguez DU, Weale AR, Brooks MJ, Mitchell DC. Delayed discharges at a major arterial centre: a 4-month cross-sectional study at a single specialist vascular surgery ward. BMJ Open. 2017;6(9):e011193. doi: https://doi.org/10.1136/bmjopen-2016-011193. https://doi.org/10.1136/bmjopen-2016-011... 12. Landeiro F, Leal J, Gray AM. The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs. Osteoporos Int. 2015;27(2):737-45. doi: https://doi.org/10.1007/s00198-015-3293-9. https://doi.org/10.1007/s00198-015-3293-... 13. Carter ND, Wade DT. Delayed discharges from Oxford city hospitals: who and why? Clin Rehabil. 2002;16(3):315-20. doi: https://doi.org/10.1191/0269215502cr496oa. https://doi.org/10.1191/0269215502cr496o... 14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... 15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... 16. Worthington AD, Oldham JB. Delayed discharge from rehabilitation after brain injury. Clin Rehabil. 2006;20(1):79-82. doi: https://doi.org/10.1191/0269215506cr881oa. https://doi.org/10.1191/0269215506cr881o... 17. García FS, Oterino de la Fuente D, Peiró S, Librero J, Raya CB, García de León NP, et al. Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años. Rev Esp Salud Publica. 2001 [cited 2017 Aug 5];75(3):237-48. Available from: http://scielo.isciii.es/pdf/resp/v75n3/a07v75n3.pdf. http://scielo.isciii.es/pdf/resp/v75n3/a... ^-¹⁸18. Benson RT, Drew JC, Galland RB. A waiting list to go home: an analysis of delayed discharges from surgical beds. Ann R Coll Surg Engl. 2006;88(7):650-2. doi: https://doi.org/10.1308/003588406X149246. https://doi.org/10.1308/003588406X149246...
	Waiting for treatment in the community⁴4. Majeed UM, Williams DT, Pollock R, Amir F, Liam M, Foong KS, et al. Delay in discharge and its impact on unnecessary hospital bed occupancy. BMC Health Serv Res. 2012 [cited 2017 Aug 4];12:410. doi: https://doi.org/10.1186/1472-6963-12-410. https://doi.org/10.1186/1472-6963-12-410... ^,⁹9. Hendy P, Patel JH, Kordbacheh T, Laskar N, Harbord M. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med [Lond]. 2012;12(4):320-3. doi: https://doi.org/10.7861/clinmedicine.12-4-320. https://doi.org/10.7861/clinmedicine.12-... ^,¹¹11. Houghton JS, Rodriguez DU, Weale AR, Brooks MJ, Mitchell DC. Delayed discharges at a major arterial centre: a 4-month cross-sectional study at a single specialist vascular surgery ward. BMJ Open. 2017;6(9):e011193. doi: https://doi.org/10.1136/bmjopen-2016-011193. https://doi.org/10.1136/bmjopen-2016-011... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^,¹⁸18. Benson RT, Drew JC, Galland RB. A waiting list to go home: an analysis of delayed discharges from surgical beds. Ann R Coll Surg Engl. 2006;88(7):650-2. doi: https://doi.org/10.1308/003588406X149246. https://doi.org/10.1308/003588406X149246... ^,²²22. Jasinarachchi KH, Ibrahim IR, Keegan BC, Mathialagan R, McGourty JC, Phillips JRN, et al. Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over. BMC Geriatrics. 2009;9:4. doi: https://doi.org/10.1186/1471-2318-9-4. https://doi.org/10.1186/1471-2318-9-4... ^,²⁵25. Panteli M, Habeeb S, McRoberts J, Porteous MJ. Enhanced care for primary hip arthroplasty factors affecting length of hospital stay. Eur J Orthop Surg Traumatol. 2014;24(3):353-8. doi: https://doi.org/10.1007/s00590-013-1188-z. https://doi.org/10.1007/s00590-013-1188-...
	Need for care at home⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,¹⁰10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^,²²22. Jasinarachchi KH, Ibrahim IR, Keegan BC, Mathialagan R, McGourty JC, Phillips JRN, et al. Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over. BMC Geriatrics. 2009;9:4. doi: https://doi.org/10.1186/1471-2318-9-4. https://doi.org/10.1186/1471-2318-9-4...
	Safety conditions at home³3. Rambani R, Okafor B. Evaluation of factors delaying discharge in acute orthopedic wards: a prospective study. Eur J Trauma Emerg Surg. 2008 [cited 2017 Aug 3];34(1):24-8. doi: https://doi.org/10.1007/s00068-007-6184-8. https://doi.org/10.1007/s00068-007-6184-... ^,¹¹11. Houghton JS, Rodriguez DU, Weale AR, Brooks MJ, Mitchell DC. Delayed discharges at a major arterial centre: a 4-month cross-sectional study at a single specialist vascular surgery ward. BMJ Open. 2017;6(9):e011193. doi: https://doi.org/10.1136/bmjopen-2016-011193. https://doi.org/10.1136/bmjopen-2016-011... ^,¹³13. Carter ND, Wade DT. Delayed discharges from Oxford city hospitals: who and why? Clin Rehabil. 2002;16(3):315-20. doi: https://doi.org/10.1191/0269215502cr496oa. https://doi.org/10.1191/0269215502cr496o...

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Diana Andreia Santos Modas diana.modas@gmail.com