title: An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care.
abstract: The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22-67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review.
authors.affiliation: Department of Nursing Science, University of Turku, 20520 Turku, Finland ; ICU, TG3B, Turku University Hospital, Hospital District of Southwest Finland, Kiinamyllynkatu 4-8, 20520 Turku, Finland.
authors.forename: Laura-Maria
authors.initials: LM
authors.lastname: Peltonen
authors.affiliation: School Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK ; School of Health, Nursing & Midwifery, University of West of Scotland, Ayr, Ayrshire KA8 0SX, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: McCallum
authors.affiliation: Department of Nursing Science, University of Turku, 20520 Turku, Finland.
authors.forename: Eriikka
authors.initials: E
authors.lastname: Siirala
authors.affiliation: Intensive Care Unit, Operative Profit Centre, Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland.
authors.forename: Marjaana
authors.initials: M
authors.lastname: Haataja
authors.affiliation: Hospital District of Southwest Finland, Administrative Centre, Bureau of Nursing Care, P.O. Box 52, 20521 Turku, Finland.
authors.forename: Heljä
authors.initials: H
authors.lastname: Lundgrén-Laine
authors.affiliation: Department of Nursing Science, University of Turku, 20520 Turku, Finland ; Hospital District of Southwest Finland, Administrative Centre, Bureau of Nursing Care, P.O. Box 52, 20521 Turku, Finland.
authors.forename: Sanna
authors.initials: S
authors.lastname: Salanterä
authors.affiliation: School of Nursing and Midwifery, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222, Australia.
authors.forename: Frances
authors.initials: F
authors.lastname: Lin
mesh_terms: D003422:Critical Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data; D013997:Time Factors