title: Factors associated with delayed discharges after inpatient stroke rehabilitation in Singapore.
abstract: BACKGROUND
  This study determines the extent of, and factors associated with, delayed discharges for stroke patients from inpatient rehabilitation.
  
  
  METHODS
  A retrospective cohort study utilising medical notes review was conducted at an inpatient rehabilitation centre in Singapore. Acute stroke patients (n = 487) admitted between March 2005 and December 2006 were studied. The primary measure was delayed discharge defined as an extension in inpatient stay beyond the planned duration. Factors associated with delays in discharge were categorised as individual, caregiver, medical and organisational.
  
  
  RESULTS
  There were a total of 172 delayed discharges (35.6%). The mean [standard deviation (SD)] length of stay was 40.5 days (SD, 19.5 days) and 25.8 days (SD, 11.4 days) for patients with delayed and prompt discharges, respectively. Mean extension of stay was 9.7 days (SD, 13.8 days). Caregiver-related reasons were cited for 79.7% of the delays whereas organisational factors (awaiting nursing home placement, investigations or specialist appointments) accounted for 17.4%. Four factors were found to be independently associated with delayed discharge: discharge to the care of foreign domestic helper, nursing home placement, lower admission Functional Independence Measure (FIM) motor score and discharge planning process.
  
  
  CONCLUSIONS
  Our study suggests that caregiver and organisational factors were main contributors of delayed discharge. Targeted caregiver training and the provision of post-discharge support may improve the confidence of caregivers of patients with greater motor disability. The use of structured discharge planning programmes may improve the efficiency of the rehabilitation service. To reduce delays, problems with the supply of formal and informal post-discharge care must also be addressed.
authors.affiliation: Health Services and Outcomes Research, National Healthcare Group, Singapore. woan_shin_tan@nhg.com.sg
authors.forename: Woan Shin
authors.initials: WS
authors.lastname: Tan
authors.forename: Wai Fung
authors.initials: WF
authors.lastname: Chong
authors.forename: Karen S G
authors.initials: KS
authors.lastname: Chua
authors.forename: Bee Hoon
authors.initials: BH
authors.lastname: Heng
authors.forename: Kay Fei
authors.initials: KF
authors.lastname: Chan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012846:Singapore; D000071939:Stroke Rehabilitation