Table 1:

System, provider, and patient level factors that can complicate safe discharges, collated from qualitative staff and patient studies.^5,27-29

System factors	Provider factors	Patient factors
Insurance issues: precertification for medications or home health or nursing facility placement	Patient load	Complex interacting comorbidities
Barriers to access to outpatient resources	Implicit biases	Polypharmacy
No communication between electronic health record systems	Lack of training	Cognitive impairment
Minimal face to face time with the patient and heavy charting requirements	Perception that it takes too much time	Low health literacy or educational level
Multiple handoffs and multiple providers	Focus on acute issue only in the ED leads to disregarding chronic issues	Lack of social support
Reduced services due to time of day or weekend transitions	Low engagement with community partners	Cultural preferences on communication and family involvement
Lack of in person or face-to-face handoffs	Difficulty tailoring instructions to individuals	Communication difficulties (e.g., sensory impairment, language barriers)
Poor integration of transitions of care services	Minimal planning time for discharge from the ED compared to inpatient time
Lack of inpatient-outpatient continuity of providers	Limited training in transitional care principles
ED crowding and/or inadequate staffing