Improving delayed discharge in gastrointestinal surgery patients: An integrative review

Abstract

Background

Delayed discharge is a global challenge that strains healthcare systems and affects patient outcomes. In gastrointestinal surgery patients, delays often result from a continuum, clinical complications prolong the acute stay and create additional care needs, such as rehabilitation and specialised homecare, which lead to further delays. However, existing literature provides limited insight into this patient group, as most studies generalise the issue. A focused integrative review is therefore needed to synthesise the causes, impacts, and strategies of delayed discharge and to inform more effective discharge planning.

Objective

This review aims to synthesise evidence related to delayed discharge in patients undergoing gastrointestinal surgery. Specifically, it seeks to: (1) identify multi-level contributing factors (patient, clinical, and healthcare system); (2) evaluate significant clinical and economic impacts on patients, family, healthcare staff and healthcare system; and (3) identify and describe effective interventions implemented to promote timely and safe discharge in this population.

Method

A literature search was conducted across CINAHL, Medline, Scopus, Cochrane, and PsycINFO databases for studies published from 2000 to January 2025. Keywords used included “delayed discharge,” “factors,” “impact,” “gastrointestinal surgery,” and “intervention.” Inclusion criteria focused on peer-reviewed studies involving adult gastrointestinal surgery patients in acute hospital settings. Two authors independently screened titles, abstracts, and full texts using the Joanna Briggs Institute SUMARI software. The methodological quality of studies was assessed using the Joanna Briggs Institute critical appraisal tools. Data extraction focused on study characteristics, factors, impacts, and interventions, followed by a deductive narrative analysis to identify patterns and relationships.

Results

Of the 572 articles identified, 20 met inclusion criteria: 17 cohort studies (12 retrospective, five prospective), one analytic cross-sectional study, and two clinical trials. The findings encompassed the length of stay and delayed discharge rate, contributing factors, impacts, and potential interventions. Delayed discharge stemmed from patient, surgical, and system-related factors, affecting patients and hospital efficiency. Targeted interventions, like nurse-led stoma education and streamlined discharge criteria, significantly reduced delays (p < 0.0001).

Conclusion

Delayed discharge in gastrointestinal surgery patients stems from a complex interplay of patient, surgical, and systemic factors, affecting both individual and healthcare system. Evidence supports nurse-led and multidisciplinary approaches in mitigating delays, improving outcomes and enhancing healthcare efficiency. Future research should employ qualitative or mixed-methods approaches to explore the psychosocial impacts on patients, families, and healthcare staff, in collaboration with comprehensive, multidisciplinary discharge strategies.