Ms Aruska D’Souza1,2, Associate Professor Catherine Said1,3, Ms Melanie Tomkins2,3, Ms Nina Leggett2,3, Ms Jacqueline Kay2, Dr Catherine Granger1,2
1University of Melbourne, Parkville, Australia, 2Melbourne Health, Parkville, Australia, 3Western Health, Sunshine, Australia
Background: Timely discharge has potential to improve quality of care and reduce length of stay. This systematic review aimed to identify assessment tools (containing multiple items) and factors (single items) associated with discharge destination (home, subacute or residential care) in general medical inpatients.
Method: Protocol registered a priori on PROSPERO (CRD42017064209). Five electronic databases were searched. Studies were eligible for inclusion if they were: a prospective or retrospective quantitative study design, with a minimum of 20 adult acute general medical inpatients and published in English. Outcomes of interests were assessment tools or patient factors with statistical correlations with discharge destination. Articles were screened by two independent assessors. Data were extracted by one reviewer and independently checked by a second reviewer. Data were analysed/described descriptively.
Results: Twenty-three studies were included. Within included studies, tools and factors spanned ‘cognitive’, ‘functional’, ‘mobility’, ‘medical’, ‘social’ and ‘other’ domains. Fifteen tools associated with discharge were identified; 13 were associated with discharge to residential care, 11 with discharge home and 2 with subacute. The most commonly researched tools were the Mental Status Questionnaire/Short Portable Mental Status Questionnaire, the Mini-Mental State Examination, the Barthel Index, the Katz Index and the Lawton ADL Index (each investigated in two studies). Thirty-nine factors associated with discharge were identified; 28 were associated with discharge home, 15 with subacute and 23 with residential care. The most commonly researched factors were age and patient/carer’s wishes about returning home (each investigated in eight studies).
Discussion: The large number of tools and factors found, as well as their distribution across several domains, exemplifies the complexities of discharge planning. There is no single tool that best predicts discharge destination for this complex cohort. Further research is needed to determine the psychometric properties of the tools identified as well as additional predictors of subacute care.
Ms D’Souza is a senior physiotherapist who graduated from La Trobe University in 2010 and has worked in the public health system for over eight years. She currently works at the Royal Melbourne Hospital. Ms D’Souza was the successful recipient of the Mary Elizabeth Watson Early Career Fellowship in Allied Health and commence a PhD part time at the University of Melbourne. Her PhD topic aims to investigate discharge from acute general medical wards. She is the lead researcher in a systematic review, two observational studies and a qualitative study. Ms D’Souza was successful in a poster presentation at the 2017 national Australian Physiotherapy Association conference and a table top discussion at the 2018 Australian Association of Gerontology conference.