Causas de atraso na alta hospitalar no cliente adulto: scoping review

Efetuada revisão da literatura do tipo scoping review. Pesquisou-se na plataforma informática da Ebscohost, na PubMed e na literatura cinzenta, consultando-se as referências bibliográficas desses documentos.

RESULTADOS

Dos 22 artigos analisados verificou-se que o atraso na alta hospitalar se deve a causas relacionadas com os recursos da comunidade, designadamente a falta de vagas em unidades de saúde e motivos sociais; a causas organizacionais relacionadas com os cuidados de saúde; a causas individuais, destacando-se as questões familiares e financeiras; culminando nas causas organizacionais relacionadas com a gestão hospitalar.

CONCLUSÃO

O atraso na alta hospitalar é multifatorial, tornando-se necessário monitorizar o processo de internação, apostando-se num planejamento de alta antecipado.

PALAVRAS Chave:
Alta do paciente; Cuidados de enfermagem; Tempo de internação

Causas	Subtipo de causas
Organizacionais Relacionadas com os cuidados de saúde	Aguarda avaliação de saúde, tratamento ou resultados de exames⁴4. Majeed UM, Williams DT, Pollock R, Amir F, Liam M, Foong KS, et al. Delay in discharge and its impact on unnecessary hospital bed occupancy. BMC Health Serv Res. 2012 [cited 2017 Aug 4];12:410. doi: https://doi.org/10.1186/1472-6963-12-410. https://doi.org/10.1186/1472-6963-12-410... ^,⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^-¹⁵15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... ^,¹⁷17. García FS, Oterino de la Fuente D, Peiró S, Librero J, Raya CB, García de León NP, et al. Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años. Rev Esp Salud Publica. 2001 [cited 2017 Aug 5];75(3):237-48. Available from: http://scielo.isciii.es/pdf/resp/v75n3/a07v75n3.pdf. http://scielo.isciii.es/pdf/resp/v75n3/a... ^-¹⁸18. Benson RT, Drew JC, Galland RB. A waiting list to go home: an analysis of delayed discharges from surgical beds. Ann R Coll Surg Engl. 2006;88(7):650-2. doi: https://doi.org/10.1308/003588406X149246. https://doi.org/10.1308/003588406X149246... ^,²²22. Jasinarachchi KH, Ibrahim IR, Keegan BC, Mathialagan R, McGourty JC, Phillips JRN, et al. Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over. BMC Geriatrics. 2009;9:4. doi: https://doi.org/10.1186/1471-2318-9-4. https://doi.org/10.1186/1471-2318-9-4...
	Queda¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-...
	Gestão da dor¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-...
	Cuidados de reabilitação intra-hospitalar¹⁰10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983... ^,²⁴24. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011;82(6):679-84. doi: https://doi.org/10.3109/17453674.2011.636682. https://doi.org/10.3109/17453674.2011.63...
	Número de procedimentos realizados²2. Holmås TH, Islam MK, Kjerstad E. Between two beds: inappropriately delayed discharges from hospitals. Int J Health Care Finance Econ. 2013 [cited 2017 Aug 5];13(3-4):201-17. doi: https://doi.org/10.1007/s10754-013-9135-4. https://doi.org/10.1007/s10754-013-9135-...
	Necessidade de cateterização vesical²⁴24. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011;82(6):679-84. doi: https://doi.org/10.3109/17453674.2011.636682. https://doi.org/10.3109/17453674.2011.63... ^-²⁵25. Panteli M, Habeeb S, McRoberts J, Porteous MJ. Enhanced care for primary hip arthroplasty factors affecting length of hospital stay. Eur J Orthop Surg Traumatol. 2014;24(3):353-8. doi: https://doi.org/10.1007/s00590-013-1188-z. https://doi.org/10.1007/s00590-013-1188-...
	Necessidade de transfusão sanguínea²⁰20. Reddy KM, Meyer CE, Palazzo FF, Conaghan P, Blunt MC, Stebbings WS, et al. Postoperative stay following colorectal surgery: a study of factors associated with prolonged hospital stay. Ann R Coll Surg Engl. 2003;85(2):111-4. doi: https://doi.org/10.1308/003588403321219894. https://doi.org/10.1308/0035884033212198... ^,²⁴24. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011;82(6):679-84. doi: https://doi.org/10.3109/17453674.2011.636682. https://doi.org/10.3109/17453674.2011.63... ^-²⁵25. Panteli M, Habeeb S, McRoberts J, Porteous MJ. Enhanced care for primary hip arthroplasty factors affecting length of hospital stay. Eur J Orthop Surg Traumatol. 2014;24(3):353-8. doi: https://doi.org/10.1007/s00590-013-1188-z. https://doi.org/10.1007/s00590-013-1188-...
	Utilização de analgesia controlada pelo paciente²⁵25. Panteli M, Habeeb S, McRoberts J, Porteous MJ. Enhanced care for primary hip arthroplasty factors affecting length of hospital stay. Eur J Orthop Surg Traumatol. 2014;24(3):353-8. doi: https://doi.org/10.1007/s00590-013-1188-z. https://doi.org/10.1007/s00590-013-1188-...
	Preparação da alta⁴4. Majeed UM, Williams DT, Pollock R, Amir F, Liam M, Foong KS, et al. Delay in discharge and its impact on unnecessary hospital bed occupancy. BMC Health Serv Res. 2012 [cited 2017 Aug 4];12:410. doi: https://doi.org/10.1186/1472-6963-12-410. https://doi.org/10.1186/1472-6963-12-410...
	Referenciação pelo enfermeiro³3. Rambani R, Okafor B. Evaluation of factors delaying discharge in acute orthopedic wards: a prospective study. Eur J Trauma Emerg Surg. 2008 [cited 2017 Aug 3];34(1):24-8. doi: https://doi.org/10.1007/s00068-007-6184-8. https://doi.org/10.1007/s00068-007-6184-... ^,⁹9. Hendy P, Patel JH, Kordbacheh T, Laskar N, Harbord M. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med [Lond]. 2012;12(4):320-3. doi: https://doi.org/10.7861/clinmedicine.12-4-320. https://doi.org/10.7861/clinmedicine.12-...
	Erros da equipe profissional⁴4. Majeed UM, Williams DT, Pollock R, Amir F, Liam M, Foong KS, et al. Delay in discharge and its impact on unnecessary hospital bed occupancy. BMC Health Serv Res. 2012 [cited 2017 Aug 4];12:410. doi: https://doi.org/10.1186/1472-6963-12-410. https://doi.org/10.1186/1472-6963-12-410... ^,¹⁵15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... ^,¹⁷17. García FS, Oterino de la Fuente D, Peiró S, Librero J, Raya CB, García de León NP, et al. Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años. Rev Esp Salud Publica. 2001 [cited 2017 Aug 5];75(3):237-48. Available from: http://scielo.isciii.es/pdf/resp/v75n3/a07v75n3.pdf. http://scielo.isciii.es/pdf/resp/v75n3/a...
	Infecção associada aos cuidados de saúde³3. Rambani R, Okafor B. Evaluation of factors delaying discharge in acute orthopedic wards: a prospective study. Eur J Trauma Emerg Surg. 2008 [cited 2017 Aug 3];34(1):24-8. doi: https://doi.org/10.1007/s00068-007-6184-8. https://doi.org/10.1007/s00068-007-6184-... ^,¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-... ^-²⁰20. Reddy KM, Meyer CE, Palazzo FF, Conaghan P, Blunt MC, Stebbings WS, et al. Postoperative stay following colorectal surgery: a study of factors associated with prolonged hospital stay. Ann R Coll Surg Engl. 2003;85(2):111-4. doi: https://doi.org/10.1308/003588403321219894. https://doi.org/10.1308/0035884033212198...
Organizacionais Gestão Hospitalar	Falta de recursos humanos⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^-¹⁵15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... ^,²³23. Varnava AM, Sedgwick JEC, Deaner A, Ranjadayalan K, Timmis AD. Restricted weekend service inappropriately delays discharge after acute myocardial infarction. Heart. 2002 [cited 2017 Aug 5];87(3):216-9. Available from: https://heart.bmj.com/content/heartjnl/87/3/216.full.pdf. https://heart.bmj.com/content/heartjnl/8...
	Internação em duas ou mais especialidades médicas¹⁰10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983...
	Dia da admissão¹⁵15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... ^,²³23. Varnava AM, Sedgwick JEC, Deaner A, Ranjadayalan K, Timmis AD. Restricted weekend service inappropriately delays discharge after acute myocardial infarction. Heart. 2002 [cited 2017 Aug 5];87(3):216-9. Available from: https://heart.bmj.com/content/heartjnl/87/3/216.full.pdf. https://heart.bmj.com/content/heartjnl/8...
	Trabalho da assistente social⁹9. Hendy P, Patel JH, Kordbacheh T, Laskar N, Harbord M. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med [Lond]. 2012;12(4):320-3. doi: https://doi.org/10.7861/clinmedicine.12-4-320. https://doi.org/10.7861/clinmedicine.12-...
Pessoais / Individuais	Patologia associada²2. Holmås TH, Islam MK, Kjerstad E. Between two beds: inappropriately delayed discharges from hospitals. Int J Health Care Finance Econ. 2013 [cited 2017 Aug 5];13(3-4):201-17. doi: https://doi.org/10.1007/s10754-013-9135-4. https://doi.org/10.1007/s10754-013-9135-... ^,¹⁰10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983... ^,¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-...
	Aumento do nível de dependência¹⁰10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983... ^,¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-...
	Questões familiares⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^-⁸8. Lenzi J, Mongardi M, Rucci P, Di Ruscio E, Vizioli M, Randazzo C, et al. Sociodemographic, clinical and organizational factors associated with delayed hospital discharges: a cross-sectional study. BMC Health Serv Res. 2014;14:128. doi: https://doi.org/10.1186/1472-6963-14-128. https://doi.org/10.1186/1472-6963-14-128... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^-¹⁵15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... ^,¹⁷17. García FS, Oterino de la Fuente D, Peiró S, Librero J, Raya CB, García de León NP, et al. Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años. Rev Esp Salud Publica. 2001 [cited 2017 Aug 5];75(3):237-48. Available from: http://scielo.isciii.es/pdf/resp/v75n3/a07v75n3.pdf. http://scielo.isciii.es/pdf/resp/v75n3/a... ^,²¹21. Giraldo DM, Navarro A, Quijano AS, Villegas A, Marchante RA, Otero EL. Retraso del alta hospitalaria por motivos no medicos. Rev Clin Espanola. 2012;212(5):229-34. doi: https://doi.org/10.1016/j.rce.2011.12.009. https://doi.org/10.1016/j.rce.2011.12.00...
	Questões financeiras⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^,¹⁶16. Worthington AD, Oldham JB. Delayed discharge from rehabilitation after brain injury. Clin Rehabil. 2006;20(1):79-82. doi: https://doi.org/10.1191/0269215506cr881oa. https://doi.org/10.1191/0269215506cr881o...
Da comunidade	Causas sociais³3. Rambani R, Okafor B. Evaluation of factors delaying discharge in acute orthopedic wards: a prospective study. Eur J Trauma Emerg Surg. 2008 [cited 2017 Aug 3];34(1):24-8. doi: https://doi.org/10.1007/s00068-007-6184-8. https://doi.org/10.1007/s00068-007-6184-... ^,⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,⁹9. Hendy P, Patel JH, Kordbacheh T, Laskar N, Harbord M. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med [Lond]. 2012;12(4):320-3. doi: https://doi.org/10.7861/clinmedicine.12-4-320. https://doi.org/10.7861/clinmedicine.12-... ^,¹²12. Landeiro F, Leal J, Gray AM. The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs. Osteoporos Int. 2015;27(2):737-45. doi: https://doi.org/10.1007/s00198-015-3293-9. https://doi.org/10.1007/s00198-015-3293-... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^,¹⁷17. García FS, Oterino de la Fuente D, Peiró S, Librero J, Raya CB, García de León NP, et al. Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años. Rev Esp Salud Publica. 2001 [cited 2017 Aug 5];75(3):237-48. Available from: http://scielo.isciii.es/pdf/resp/v75n3/a07v75n3.pdf. http://scielo.isciii.es/pdf/resp/v75n3/a... ^,¹⁹19. Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, et al. Difficult hospital discharges in internal medicine wards. Intern Emerg Med. 2007;2(2):95-9. doi: https://doi.org/10.1007/s11739-007-0029-7. https://doi.org/10.1007/s11739-007-0029-... 20. Reddy KM, Meyer CE, Palazzo FF, Conaghan P, Blunt MC, Stebbings WS, et al. Postoperative stay following colorectal surgery: a study of factors associated with prolonged hospital stay. Ann R Coll Surg Engl. 2003;85(2):111-4. doi: https://doi.org/10.1308/003588403321219894. https://doi.org/10.1308/0035884033212198... ^-²¹21. Giraldo DM, Navarro A, Quijano AS, Villegas A, Marchante RA, Otero EL. Retraso del alta hospitalaria por motivos no medicos. Rev Clin Espanola. 2012;212(5):229-34. doi: https://doi.org/10.1016/j.rce.2011.12.009. https://doi.org/10.1016/j.rce.2011.12.00...
	Falta de vaga em lares e unidades de cuidados²2. Holmås TH, Islam MK, Kjerstad E. Between two beds: inappropriately delayed discharges from hospitals. Int J Health Care Finance Econ. 2013 [cited 2017 Aug 5];13(3-4):201-17. doi: https://doi.org/10.1007/s10754-013-9135-4. https://doi.org/10.1007/s10754-013-9135-... ^,³3. Rambani R, Okafor B. Evaluation of factors delaying discharge in acute orthopedic wards: a prospective study. Eur J Trauma Emerg Surg. 2008 [cited 2017 Aug 3];34(1):24-8. doi: https://doi.org/10.1007/s00068-007-6184-8. https://doi.org/10.1007/s00068-007-6184-... ^,⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,⁸8. Lenzi J, Mongardi M, Rucci P, Di Ruscio E, Vizioli M, Randazzo C, et al. Sociodemographic, clinical and organizational factors associated with delayed hospital discharges: a cross-sectional study. BMC Health Serv Res. 2014;14:128. doi: https://doi.org/10.1186/1472-6963-14-128. https://doi.org/10.1186/1472-6963-14-128... 9. Hendy P, Patel JH, Kordbacheh T, Laskar N, Harbord M. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med [Lond]. 2012;12(4):320-3. doi: https://doi.org/10.7861/clinmedicine.12-4-320. https://doi.org/10.7861/clinmedicine.12-... 10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983... 11. Houghton JS, Rodriguez DU, Weale AR, Brooks MJ, Mitchell DC. Delayed discharges at a major arterial centre: a 4-month cross-sectional study at a single specialist vascular surgery ward. BMJ Open. 2017;6(9):e011193. doi: https://doi.org/10.1136/bmjopen-2016-011193. https://doi.org/10.1136/bmjopen-2016-011... 12. Landeiro F, Leal J, Gray AM. The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs. Osteoporos Int. 2015;27(2):737-45. doi: https://doi.org/10.1007/s00198-015-3293-9. https://doi.org/10.1007/s00198-015-3293-... 13. Carter ND, Wade DT. Delayed discharges from Oxford city hospitals: who and why? Clin Rehabil. 2002;16(3):315-20. doi: https://doi.org/10.1191/0269215502cr496oa. https://doi.org/10.1191/0269215502cr496o... 14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... 15. Zambrana García JL, Delgado Fernández M, Cruz Caparrós G, Martín Escalante MD, Díez García F, Ruiz Bailén M. Factores predictivos de estancias no adecuadas en un servicio de medicina interna. Med Clin. 2001;117(3):90-2. doi: https://doi.org/10.1016/S0025-7753(01)72026-X. https://doi.org/10.1016/S0025-7753(01)72... 16. Worthington AD, Oldham JB. Delayed discharge from rehabilitation after brain injury. Clin Rehabil. 2006;20(1):79-82. doi: https://doi.org/10.1191/0269215506cr881oa. https://doi.org/10.1191/0269215506cr881o... 17. García FS, Oterino de la Fuente D, Peiró S, Librero J, Raya CB, García de León NP, et al. Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años. Rev Esp Salud Publica. 2001 [cited 2017 Aug 5];75(3):237-48. Available from: http://scielo.isciii.es/pdf/resp/v75n3/a07v75n3.pdf. http://scielo.isciii.es/pdf/resp/v75n3/a... ^-¹⁸18. Benson RT, Drew JC, Galland RB. A waiting list to go home: an analysis of delayed discharges from surgical beds. Ann R Coll Surg Engl. 2006;88(7):650-2. doi: https://doi.org/10.1308/003588406X149246. https://doi.org/10.1308/003588406X149246...
	Aguarda tratamento na comunidade⁴4. Majeed UM, Williams DT, Pollock R, Amir F, Liam M, Foong KS, et al. Delay in discharge and its impact on unnecessary hospital bed occupancy. BMC Health Serv Res. 2012 [cited 2017 Aug 4];12:410. doi: https://doi.org/10.1186/1472-6963-12-410. https://doi.org/10.1186/1472-6963-12-410... ^,⁹9. Hendy P, Patel JH, Kordbacheh T, Laskar N, Harbord M. In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience. Clin Med [Lond]. 2012;12(4):320-3. doi: https://doi.org/10.7861/clinmedicine.12-4-320. https://doi.org/10.7861/clinmedicine.12-... ^,¹¹11. Houghton JS, Rodriguez DU, Weale AR, Brooks MJ, Mitchell DC. Delayed discharges at a major arterial centre: a 4-month cross-sectional study at a single specialist vascular surgery ward. BMJ Open. 2017;6(9):e011193. doi: https://doi.org/10.1136/bmjopen-2016-011193. https://doi.org/10.1136/bmjopen-2016-011... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^,¹⁸18. Benson RT, Drew JC, Galland RB. A waiting list to go home: an analysis of delayed discharges from surgical beds. Ann R Coll Surg Engl. 2006;88(7):650-2. doi: https://doi.org/10.1308/003588406X149246. https://doi.org/10.1308/003588406X149246... ^,²²22. Jasinarachchi KH, Ibrahim IR, Keegan BC, Mathialagan R, McGourty JC, Phillips JRN, et al. Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over. BMC Geriatrics. 2009;9:4. doi: https://doi.org/10.1186/1471-2318-9-4. https://doi.org/10.1186/1471-2318-9-4... ^,²⁵25. Panteli M, Habeeb S, McRoberts J, Porteous MJ. Enhanced care for primary hip arthroplasty factors affecting length of hospital stay. Eur J Orthop Surg Traumatol. 2014;24(3):353-8. doi: https://doi.org/10.1007/s00590-013-1188-z. https://doi.org/10.1007/s00590-013-1188-...
	Necessidade de cuidados no domicílio⁷7. Bryan K, Gage H, Gilbert K. Delayed transfers of older people from hospital: causes and policy implications. Health Policy. 2006;76(2):194-201. doi: https://doi.org/10.1016/j.healthpol.2005.06.005. https://doi.org/10.1016/j.healthpol.2005... ^,¹⁰10. Challis D, Hughes J, Xie C, Jolley D. An examination of factors influencing delayed discharge of older people from hospital. Int J Geriatr Psychiatry. 2014;29(2):160-8. doi: https://doi.org/10.1002/gps.3983. https://doi.org/10.1002/gps.3983... ^,¹⁴14. Glasby J, Littlechild R, Pryce K. All dressed up but nowhere to go? delayed hospital discharges and older people. J Health Serv Res Policy. 2006;11(1):52-8. doi: https://doi.org/10.1258/135581906775094208. https://doi.org/10.1258/1355819067750942... ^,²²22. Jasinarachchi KH, Ibrahim IR, Keegan BC, Mathialagan R, McGourty JC, Phillips JRN, et al. Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over. BMC Geriatrics. 2009;9:4. doi: https://doi.org/10.1186/1471-2318-9-4. https://doi.org/10.1186/1471-2318-9-4...
	Condições de segurança em casa³3. Rambani R, Okafor B. Evaluation of factors delaying discharge in acute orthopedic wards: a prospective study. Eur J Trauma Emerg Surg. 2008 [cited 2017 Aug 3];34(1):24-8. doi: https://doi.org/10.1007/s00068-007-6184-8. https://doi.org/10.1007/s00068-007-6184-... ^,¹¹11. Houghton JS, Rodriguez DU, Weale AR, Brooks MJ, Mitchell DC. Delayed discharges at a major arterial centre: a 4-month cross-sectional study at a single specialist vascular surgery ward. BMJ Open. 2017;6(9):e011193. doi: https://doi.org/10.1136/bmjopen-2016-011193. https://doi.org/10.1136/bmjopen-2016-011... ^,¹³13. Carter ND, Wade DT. Delayed discharges from Oxford city hospitals: who and why? Clin Rehabil. 2002;16(3):315-20. doi: https://doi.org/10.1191/0269215502cr496oa. https://doi.org/10.1191/0269215502cr496o...

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