A long wait: barriers to discharge for long length of stay patients

Zhao, Emma; Yeluru, Apurva; Manjunath, L.; Zhong, Lei; Hsu, Hsiao-Tieh; Lee, Charles K.; Wong, Anna; Abramian, Matthew; Manella, Haley; Svec, David; Shieh, Lisa

doi:10.1136/postgradmedj-2018-135815

Cited by 26 publications

(24 citation statements)

References 17 publications

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“…Coordination of discharge to a facility often takes a longer LOS [22]. There was not much of a difference in percentages of patients between the four clinical groups who were discharged to nursing facilities, including SNFs and NHs.…”

Section: Discussionmentioning

confidence: 90%

Shorter length of hospital stay for hip fracture in those with dementia and without a known diagnosis of osteoporosis in the USA

et al. 2020

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Background About 50% of all hospitalized fragility fracture cases in older Americans are hip fractures. Approximately 3/4 of fracture-related costs in the USA are attributable to hip fractures, and these are mostly covered by Medicare. Hip fracture patients with dementia, including Alzheimer’s disease, have worse health outcomes including longer hospital length of stay (LOS) and charges. LOS and hospital charges for dementia patients are usually higher than for those without dementia. Research describing LOS and acute care charges for hip fractures has mostly focused on these outcomes in trauma patients without a known pre-admission diagnosis of osteoporosis (OP). Lack of documented diagnosis put patients at risk of not having an appropriate treatment plan for OP. Whether having a diagnosis of OP would have an effect on hospital outcomes in dementia patients has not been explored. We aim to investigate whether having a diagnosis of OP, dementia, or both has an effect on LOS and hospital charges. In addition, we also report prevalence of common comorbidities in the study population and their effects on hospital outcomes. Methods We conducted a cross-sectional analysis of claims data (2012–2013) for 2175 Medicare beneficiaries (≥65 years) in the USA. Results Compared to those without OP or dementia, patients with demenia only had a shorter LOS (by 5%; P = .04). Median LOS was 6 days (interquartile range [IQR]: 5–7), and the median hospital charges were $45,100 (IQR: 31,500 − 65,600). In general, White patients had a shorter LOS (by 7%), and those with CHF and ischemic heart disease (IHD) had longer LOS (by 7 and 4%, respectively). Hospital charges were 6% lower for women, and 16% lower for White patients. Conclusion This is the first study evaluating LOS in dementia in the context of hip fracture which also disagrees with previous reporting about longer LOS in dementia patients. Patients with CHF and IHD remains at high risk for longer LOS regardless of their diagnosis of dementia or OP.

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Section: Discussionmentioning

confidence: 90%

Shorter length of hospital stay for hip fracture in those with dementia and without a known diagnosis of osteoporosis in the USA

et al. 2020

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“…In the United States, only 2% of hospitalizations are prolonged (≥21 days), but they account for nearly 15% of overall hospital bed-days 1 ; a large proportion of these may occur when discharge is medically appropriate. [2][3][4] Barriers to discharge for patients that are "medically ready" are multifaceted and often related to underlying clinical, financial, behavioral, or psychosocial conditions in already marginalized, vulnerable individuals. 5 In many respects, these are symptoms of larger issues in our health care system, including a lack of long-term care services, a dearth of critical community resources, and administrative inefficiencies that put these patients at undue risk.…”

Section: Introductionmentioning

confidence: 99%

Getting Unstuck: Challenges and Opportunities in Caring for Patients Experiencing Prolonged Hospitalization While Stable for Discharge

Meo

Bann

Sanchez

et al. 2020

The American Journal of Medicine

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Many physicians care for patients who remain in the hospital for prolonged periods despite being "medically ready" or stable for discharge. However, this phenomenon is not well-defined, and optimal strategies to address the problem are not known. A prolonged hospitalization past the point of medical necessity can harm patients, frustrate care teams, and is costly for the health care system. In this perspective, we describe opportunities to improve value of care for these patients through the lens of the Quadruple Aim, a common framework used to guide health care transformation efforts. We then offer recommendations, including some employed by our hospitals, for clinicians, researchers, and health care systems to improve the care for patients who are "stuck" in the hospital.

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“…These include lack of patient and/or family/caregiver "readiness," hospital operation delays (eg, specialty diagnostic tests or procedures, consultant recommendations), or availability of a post-acute care facility. [14][15][16] For the extended and prolonged cohorts, these themes frequently arose in our multidisciplinary groups.…”

Section: Discussionmentioning

confidence: 99%

Focusing on the Medically Ready for Discharge Patient Using a Reliable Design Strategy: A Quality Improvement Project to Improve Length of Stay on a Medicine Service

Meo

Cornia

2021

Quality Management in Health Care

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Background and Objectives: Length of stay is a common measure of efficiency of care. We aimed to reduce length of stay on a general medicine service through a structured quality improvement project. Methods: A reliable design strategy was implemented in successive stages at a 238-bed academically-affiliated VA hospital. Over a 2-year period, continuous improvement efforts were directed at discrete cohorts of patients deemed medically appropriate for discharge but who remained hospitalized because of discharge barriers. We compared the mean length of stay and medically-ready bed days of care for a hospital in statistical control charts. Pre-and post-intervention comparisons were made using t-tests. Results: In total, 5321 discharges were included in this improvement project, accounting for 35 852 bed days of care. Overall, average length of stay was reduced by 15.7%, from 7.62 to 6.40 days (P < .05). There was a significant reduction in the mean number of medically-ready bed days of care from 2.3 to 1.72. Statistical process control charts demonstrated special cause variation across patient cohorts. Conclusion: A quality improvement project using reliable design principles was associated with shorter length of stay.

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A long wait: barriers to discharge for long length of stay patients

Cited by 26 publications

References 17 publications

Shorter length of hospital stay for hip fracture in those with dementia and without a known diagnosis of osteoporosis in the USA

Shorter length of hospital stay for hip fracture in those with dementia and without a known diagnosis of osteoporosis in the USA

Getting Unstuck: Challenges and Opportunities in Caring for Patients Experiencing Prolonged Hospitalization While Stable for Discharge

Focusing on the Medically Ready for Discharge Patient Using a Reliable Design Strategy: A Quality Improvement Project to Improve Length of Stay on a Medicine Service

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