Alexander Micallef - Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
Sandra Buttigieg - Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
Gianpaolo Tomaselli - Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
Lalit Garg - Department of Computer Information Systems, Faculty of ICT, University of Malta, Msida, Malta

BackgroundWith the ever-increasing demand on acute healthcare, the hospital discharge process and delayed discharges are considered relevant in achieving optimal performance in clinical settings. The purpose of this paper is to review the literature to identify conceptual and operational definitions of delayed discharges, identify causes and effects of delayed discharges, and also to explore the literature for interventions aimed at decreasing the impact (in terms of reducing the number/rate of delays) of delayed discharges in acute healthcare settings.MethodsAn extensive literature search yielded a total of ۲۶ ۲۴۸ records. Sixty-four research articles were included in the scoping review after considering inclusion/exclusion criteria and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) search strategy. The following databases were utilized: Cochrane, EBSCO, PubMed, PubMed Central, Medline, and Web of Science. The search was carried out between January ۲۰۱۷ and March ۲۰۲۰ and covered literature ranging from ۱۹۹۰ to ۲۰۱۹. Results were reviewed by authors for duplicates and filtered using the inclusion/exclusion criteria. Tables were created to classify the chosen articles (n = ۶۴), allowing us to organise findings and results.ResultsConceptual and operational definitions were analysed. In turn, causes and effects of delayed discharges were extracted and represented in diagrammatic format, together with specific interventions used in acute healthcare settings to lessen the effect of delayed discharges. Operational definitions of delayed discharges were found to be more difficult to establish, particularly in the light of the vast number of different scenarios and workplace interventions uncovered in the literature. The main causes of delayed discharges were faulty organisational management, inadequate discharge planning, transfer of care problems, and age. The main effects were bed-blocking, A&E (Accident & Emergency) overcrowding, and financial implications. The main interventions included ‘discharge before noon’ initiative, ‘discharge facilitation tools,’ ‘discharge delay tracking’ mechanisms, and the role of general practitioners and social care staff.ConclusionThis paper fills a gap in the fragmented literature on delayed inpatient discharges by providing a research-based perspective on conceptual and operational definitions, causes and effects, as well as interventions to minimize their impact. The findings and definitions are intended as points of reference for future research.

Acute Hospitals, Bed-Blocking, Delayed Discharges, Hospital Inpatients Flow, Transition of Care