Optimising patient flow: reducing delay to discharge from acute wards to residential aged care facilities (RACF) to improve access block in the emergency department

Emergency departments (EDs) are overcrowded and unable to meet the ever-increasing demands for healthcare. Access block is the most significant contributor to ED overcrowding. Access block refers to delays in admitted patients leaving the ED due to an unavailability of inpatient beds. The consequences of access block can be catastrophic, including adverse events, higher mortality rates, reduced quality of care, and increased costs.

Large numbers of patients who occupy acute beds are non-acute and considered safe and ready for discharge. These patients are predominantly waiting for residential aged care facility (RACF) placement. In addition to financial and patient flow strain, hospital stays longer than required creates significant risk of functional decline.

As the largest public health service in Queensland, Metro North Health has made significant investments in various successful hospital avoidance, substitution and navigation programs. However, timely access and flow of patients to RAC, which increases availability of inpatient beds for patient admission from ED, remains a significant issue. Therefore, this research investigates: How can we reduce discharge delay from acute wards to RACFs to improve access block?

This research will characterise the cohort of patients who are ready for discharge and waiting for RACF placement, and understand the barriers and solutions to discharge delay. These findings can then be used in future phases of this research program to predict patients who will have a delayed discharge, target strategies and pathways at admission, model the impact of released acute bed capacity on access block, and develop metrics for inpatient stays.