Impediments to the course and effectiveness of discharge planning.

This paper examines the proposition that "timing" (of referral) is a crucial element in determining the effectiveness of the discharge planning process. A brief review of the relevant literature is followed by the description of a study undertaken to assess the impact that various impediments had upon discharge planning practice in two matched ward populations of a large, acute care university hospital. Along with timing, three other impediments were identified and their influence assessed; (a) noncompletion of transfer forms required; (b) unavailability of an appropriate (i.e., needed level of care) bed in an approved facility; and(c) unanticipated change in the patient's medical condition. Some implications of the findings are examined and discussed, and directions for future study are identified. Appended are facsimiles of the instruments employed.