Daily rounds and management focusing on long-stay patients were effective in improving length of stay and bed occupancy

Sustained improvements needed support from the quality improvement programme and community team

To improve patient flow and emergency department overcrowding the following are needed:

1. a comprehensive, systematic approach

2. changes to resource usage

3. sharing of expertise and experience

Multidisciplinary allied health team assessment in the emergency department has no benefit in reducing hospital length of stay

Future research needs to explore the impact of the identified issues on patients, families and staff

Fines have resulted in a reduction of delayed discharges

The act has brought health and social care together

Changing delivery of care for frail elderly persons is feasible

Integrated care can reduce hospital and nursing home use, without impacting cost

Increased care on weekends may contribute to improved hospital flow, without negatively impacting clinical outcomes (30-day readmissions and mortality)

Key features of the model: proactive, restorative, collaborative and integrated, client-centred and cost-effective

Improved efficiency around discharge of elective short-stay ear, nose, throat patients

95% of ear, nose, throat patients (for simple discharge) are discharged on time

Effective leadership from hospital administrators contributes to positive outcomes for patients, staff and the economy

Improved information exchange between hospitals and nursing homes

Decreased postanaesthesia care unit length of stay and discharge delays while maintaining patient status

ALC avoidance reduces burden on patients, families and providers

Long-term solutions to improve patient flow and avoid ALC should be sustainable and align with other initiatives

Physician direct accountability can reduce unnecessary and avoidable hospital days, especially when delays are within staff control

Improved patient flow and reduced ALC days through the implementation of a multidimensional approach

Six Sigma can have a positive and sustainable impact on patient flow and length of stay

Discharge delays should be addressed through principles of Six Sigma, rather than institution-specific interventions

Improved coordination between health and long-term care is essential for addressing delayed discharges

Nurse-led discharge may increase discharge postlaparoscopic surgery without impacting patient care

Improved coordination and communication across sectors

Provided healthcare providers with learning opportunities

Addressing and improving delayed discharges requires partnerships between health and social care and a whole systems-based approach

Discharge delays can be reduced if system and process breakdowns are identified and addressed

Simulation is a suitable methodology for recording and evaluating the new postacute packages

Criteria-led discharge may be suitable for select patients in improving timeliness of discharge

Immediate impact on days delayed, but increasing rates days delayed over time suggests that Intermediate Care services may need to be adapted

Discharge planning should begin on hospital admission

Nurses should coach parents to prepare them to care for their infant at home

Additional recovery statistics should be added as outcomes of the ERAS programme

Reduced inappropriate hospital days, without impacting readmission rates

Identified processes that impact inappropriate hospital days

The restructured hospital diabetes outreach service improved outcomes for inpatients with diabetes

Healthcare information technology can facilitate bed management efficiencies

Improved coordination and overall inpatient flow

Improved health functional outcomes, delivered at a lower cost

Patients and caregivers reported positive and negative experiences with the scheme, but it may be beneficial in improving outcomes for some patients

Patients outcomes can be improved by standardising care through a critical pathway

Patients with poor functional capacity (using the Hierarchical Assessment of Balance and Mobility) may need additional services to improve discharge time after clinical stability

To practically apply buffer management, current routines, principles and beliefs should shift to focus on flow between organisations rather than within one organisation

Lean Six Sigma is effective in reducing length of stay and improving financial efficiency in trauma care

Discharge criteria can reduce inappropriate patient stays related to discharge processes

Shifting maternity care to outpatient settings can reduce hospital length of stay

Multidisciplinary discharge rounds can improve discharge efficiency, length of stay and 30-day readmissions

Nurses play a key role in delivering patient-centred care and can improve discharge planning processes

Nurses must have the appropriate knowledge about discharge planning and have the ability to communicate, coordinate and educate patients

Hospital occupancy rates and overcrowding can be improved by improving discharge processes

The project altered staff behaviour around patient discharge resulting in a better use of resources

The system crashed 2 years post-implementation

There is too much focus on length of stay and bed allocations leading to poor decision making

The programme did not reduce length of stay and was perceived negatively by staff

Diabetes inpatient specialist nurse reduced excess bed occupancy

More patients were admitted to GM services and had a shorter length of stay than OAP

Transitional care programmes can improve care for vulnerable populations by reducing health and developmental differences

Inter and intra-professional collaboration is important to standardise discharge processes, build trust and respect and improve coordination of care

A collaborative approach combining the three strategies should be considered to address ALC

Improving medication safety post kidney transplant can improve clinical outcomes (acute rejection and infection rates, readmission rates)

Improving discharge time allowed for more patients to be managed, improving revenue

Leadership support and employee participation were essential for success

The critical care outreach role did not decrease delayed discharges

Reducing delays requires a collaborative approach focusing on hospital flow, rather than just the discharge process

Pre-operatively integrating stoma management education into an enhanced recovery programme can reduce delayed discharges

Patients can be safely discharged through support from the discharge fund

NR

Healthcare solutions should be developed in partnership with health and community service providers

Quantitative measures (days delayed and costs) conflict with the social aspects of overall health and well-being

Engaging partners early in the conception of the programme was critical to its success

Community supports should be increased to keep people in their home as long as possible

Programmes and services should be aimed at restoration and reactivation

Staying home provides benefits for seniors including fewer risks (germs/ viruses) and a familiar setting compared with the hospital

This framework can help improve results around ALC avoidance and management

NR

Clinical leadership is essential for implementing these initiatives

Culture change requires support and attention to be sustained over time

Home First should be implemented as a system-wide approach

Key success factors included: eliminating long discharge processes, having engaged leadership, having measurable targets, monitoring performance and educating patients and providers

ALC is a complex issue and requires coordination across sectors

Implementation of the recommendations will help to reduce ALC days and improve patient flow

Large savings for the health system can be generated with the implementation of this intervention

Allows patients the opportunity to regain independence and return home

ALC solutions need a collaborative, cross-sectoral approach

There are a number of factors to successfully reduce delays