目的:本文讨论了延迟出院(DHD)的持续挑战,旨在提供全面的概述,合成,和可操作的,可持续计划基于对过去24年的系统回顾文章的综合。我们的研究旨在全面检查DHD,确定其主要原因,并强调在医疗机构中有效沟通和管理的重要性。
方法:我们进行了系统评论和Meta分析扩展的首选报告项目(PRISMA-ScR)方法,以综合过去二十年发表的23篇评论论文的结果。涵盖700多项研究。此外,我们采用了一个实用和全面的框架来解决DHD。植根于Linderman\的模型,我们的方法侧重于持续流程改进(CPI),这突出了高级管理层的承诺,技术/行政支持,和社会/过渡护理。我们提出的CPI方法包括几个阶段:计划,实施,数据分析,和适应,所有这些都有助于医疗保健服务的持续改进。此方法为解决DHD挑战提供了宝贵的见解和建议。
结果:我们的DHD分析揭示了跨多个维度的重要见解。首先,检查原因和干预措施发现的问题,如有限的出院目的地,发出不可持续解决方案的信号,和低效的护理协调。第二个方面探讨了患者和护理人员的经验,强调与员工不确定性和负面物理环境相关的挑战,值得注意的是护理者经验的未开发区域。第三个主题探讨了组织和个人因素,包括认知障碍和社会经济影响。研究结果强调了纳入患者数据的重要性,认识到它的复杂性和当前的回避。最后,审查了过渡和社会护理以及金融战略的作用,强调对多组分的需求,针对具体环境的干预措施,以有效解决DHD。
结论:这项研究解决了文献中的空白,挑战流行的解决方案,并提供了减少DHD的实用途径,显著提高医疗质量和患者预后。综合介绍了CPI的重要阶段,加强林德曼的工作,并提供一个务实的框架来消除延迟出院。未来的努力将解决从业者咨询,以增强观点并进一步丰富研究。
■我们的范围界定综述综合和分析了现有的系统综述文章,并强调提供实用的、可行的解决方案。虽然我们的方法不直接吸引患者,它战略性地侧重于从文献中提取见解,以创建CPI框架。这个独特的方面是有意设计的,为患者带来切实的利益,服务用户,看护者,和公众。我们的可行建议旨在改善出院流程,以获得更好的医疗保健结果和体验。此详细分析超出了理论考虑,并提供了改善医疗保健实践和政策的实用指南。
OBJECTIVE: This article addresses the persistent challenge of Delayed Hospital Discharge (DHD) and aims to provide a comprehensive overview, synthesis, and actionable, sustainable plan based on the synthesis of the systematic review articles spanning the past 24 years. Our research aims to comprehensively examine DHD, identifying its primary causes and emphasizing the significance of effective communication and management in healthcare settings.
METHODS: We conducted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) method for synthesizing findings from 23 review papers published over the last two decades, encompassing over 700 studies. In addition, we employed a practical and comprehensive framework to tackle DHD. Rooted in Linderman\'s model, our approach focused on continuous process improvement (CPI), which highlights senior management commitment, technical/administrative support, and social/transitional care. Our proposed CPI method comprised several stages: planning, implementation, data analysis, and adaptation, all contributing to continuous improvement in healthcare delivery. This method provided valuable insights and recommendations for addressing DHD challenges.
RESULTS: Our DHD analysis revealed crucial insights across multiple dimensions. Firstly, examining causes and interventions uncovered issues such as limited discharge destinations, signaling unsustainable solutions, and inefficient care coordination. The second aspect explored the patient and caregiver experience, emphasizing challenges linked to staff uncertainty and negative physical environments, with notable attention to the underexplored area of caregiver experience. The third theme explored organizational and individual factors, including cognitive impairment and socioeconomic influences. The findings emphasized the importance of incorporating patients\' data, recognizing its complexity and current avoidance. Finally, the role of transitional and social care and financial strategies was scrutinized, emphasizing the need for multicomponent, context-specific interventions to address DHD effectively.
CONCLUSIONS: This study addresses gaps in the literature, challenges prevailing solutions, and offers practical pathways for reducing DHD, contributing significantly to healthcare quality and patient outcomes. The synthesis introduces the vital CPI stage, enhancing Linderman\'s work and providing a pragmatic framework to eradicate delayed discharge. Future efforts will address practitioner consultations to enhance perspectives and further enrich the study.
UNASSIGNED: Our scoping review synthesizes and analyzes existing systematic review articles and emphasizes offering practical, actionable solutions. While our approach does not directly engage patients, it strategically focuses on extracting insights from the literature to create a CPI framework. This unique aspect is intentionally designed to yield tangible benefits for patients, service users, caregivers, and the public. Our actionable recommendations aim to improve hospital discharge processes for better healthcare outcomes and experiences. This detailed analysis goes beyond theoretical considerations and provides a practical guide to improve healthcare practices and policies.