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Delays in hospital discharge occur when patients are medically cleared but continue to remain hospitalized. Discharge delays can result in reduced levels of treatment, placing patients at risk of functional decline, falls and hospital-related adverse events. The Institute of Medicine has highlighted timely, efficient, and safe hospital discharge as a marker for quality care. Hospitals, however, are often unable to meet discharge targets. Research has shown improvements in discharge planning through system-level approaches that integrate health care and social work. The purpose of this study is to describe the development and implementation of a multidisciplinary team intervention to overcome discharge barriers for patients with prolonged hospitalization. We also evaluated the impact of the intervention on length of stay, readmission rates and care team satisfaction and morale.

Multi-Disciplinary Discharge Coordination Team to Overcome Discharge Barriers and Address the Risk of Delayed Discharges