背景:延迟放电是有问题的。它的财务成本很高,并且可能会阻碍提供最佳的患者护理,通过防止恢复正常功能和延迟其他有需要的人的接纳。本系统综述旨在整理精神病住院患者延迟出院的现有证据,并了解这些服务延迟的因素和结果。
方法:对2002年至2022年之间发表的相关文献进行了检索,PsycInfo和Embase。任何设计的研究,该组织公布了高收入国家精神病住院患者延迟出院的数据。检查儿童和青少年的研究,一般医疗或法医设置被排除.采用了叙事综合方法。使用混合方法评估工具(MMAT)评估研究质量。
结果:来自英国的18项研究,加拿大,澳大利亚,爱尔兰,挪威符合纳入标准。确定了延迟出院的六个主要原因:(1)住宿需求,(2)确保社区或康复支持的挑战,(3)资金困难,(4)家庭/照顾者因素,(5)法医考虑和(6)人不在区域内。还发现一些人口统计学和临床因素与延误有关,例如诊断为精神分裂症或其他精神病,认知障碍,并在入院前增加服务投入。失业和社会孤立也与延误有关。只有一项研究评论了延误对患者的影响,发现他们经历了缺乏选择和控制的感觉。四项研究检查了对服务的影响,识别高财务成本。
结论:总体而言,研究结果表明,延迟出院有多个相互关联的因素,应在实践和政策中加以考虑。讨论了对未来研究的建议,包括调查其他高收入国家的延迟出院,检查儿童和法医精神病学机构的延迟出院,并探索延误对患者和工作人员的影响。我们建议未来的研究在定义延迟放电方面是一致的,以提高证据基础的清晰度。
■292515。
■2021年12月9日。
BACKGROUND: Delayed discharge is problematic. It is financially costly and can create barriers to delivering best patient care, by preventing return to usual functioning and delaying admissions of others in need. This systematic review aimed to collate existing evidence on delayed discharge in psychiatric inpatient settings and to develop understanding of factors and outcomes of delays in these services.
METHODS: A search of relevant literature published between 2002 and 2022 was conducted on Pubmed, PsycInfo and Embase. Studies of any design, which published data on delayed discharge from psychiatric inpatient care in high income countries were included. Studies examining child and adolescent, general medical or forensic settings were excluded. A narrative synthesis method was utilised. Quality of research was appraised using the Mixed Methods Appraisal Tool (MMAT).
RESULTS: Eighteen studies from England, Canada, Australia, Ireland, and Norway met the inclusion criteria. Six main reasons for delayed discharge were identified: (1) accommodation needs, (2) challenges securing community or rehabilitation support, (3) funding difficulties, (4) family/carer factors, (5) forensic considerations and (6) person being out of area. Some demographic and clinical factors were also found to relate to delays, such as having a diagnosis of schizophrenia or other psychotic disorder, cognitive impairment, and increased service input prior to admission. Being unemployed and socially isolated were also linked to delays. Only one study commented on consequences of delays for patients, finding they experienced feelings of lack of choice and control. Four studies examined consequences on services, identifying high financial costs.
CONCLUSIONS: Overall, the findings suggest there are multiple interlinked factors relevant in delayed discharge that should be considered in practice and policy. Suggestions for future research are discussed, including investigating delayed discharge in other high-income countries, examining delayed discharge from child and forensic psychiatric settings, and exploring consequences of delays on patients and staff. We suggest that future research be consistent in terms used to define delayed discharge, to enhance the clarity of the evidence base.
UNASSIGNED: 292515.
UNASSIGNED: 9th December 2021.