5.K. Round table: A comparison of policies to reduce delayed discharges from hospital in four European countries

Abstract Delays for patients clinically ready for discharge from hospital to the next point of care are a common health system challenge and hold particular urgency, given the backlogs and waiting times for inpatient services in many countries. Delayed discharges are often a result of inefficiencies and coordination problems between the health and social care systems. They have implications for patients’ health and well-being, health professionals and provider organisations, and result in broader societal costs. Policies for reducing delayed discharges can be hospital-based, when the responsibility for discharge primarily rests with the hospital, such as discharge planning in Germany. They can be community-based, when municipalities or local authorities, often in charge of primary or community care, hold the responsibility, as in France's home return assistance programme. Finally, they can be cross-sectoral when administrative units share the responsibility. Health policies operate within specific health and social care systems with unique infrastructure, governance arrangements, financing, resources and challenges. However, the workshop aims to identify common factors or principles underpinning different initiatives for reducing delayed discharges and hold relevant learnings for policy-makers. One of these could be clearly legislative, structural, and provider level responsibilities. Second, planning, communication and good information can be essential to effective discharge processes. Third, sufficient resourcing to enhance community-based capacity might allow for flexibility at discharge. Fourth, financial incentives appear powerful but must operate in a balanced system and can have unintended consequences. Finally, discharge delays can be a symptom of wider health system issues. This workshop provides a platform for sharing experiences with policies to reduce delayed discharges in four European countries (Denmark, France, Germany, and Norway). The objectives of the workshop are to a) discuss policies for reducing delayed discharges, b) explore facilitating factors and challenges to implementing these policies, c) discuss how the health system context shapes the identified examples, and d) establish an opportunity for cross-country learning and debate. The workshop will start with four five-minute presentations on policies for reducing delayed discharges in Denmark, France, Germany, and Norway. The presentations will follow a common template, providing contextual information on the respective policies, facilitating factors and challenges, and evidence on effectiveness and impact. After each presentation, there will be the opportunity for audience questions. The presentations will be followed by a moderated discussion with the speakers and the audience to bring in the experience of other experts and countries. The aim will be to distil key learnings and take-away messages. Key messages • It is possible to reduce delayed discharges from hospital through a combination of policies at hospital and community level, but they need to be well-aligned. • It is crucial to involve patients and health workers across the different sectors and there is a real danger of discharging patients too early through wrong incentives.