Discharge delay in acute care: reasons and determinants of delay in general ward patients

Abstract

To identify the reasons and determinants of discharge delay in acute care patients, information associated with delayed discharge was extracted from the medical record of 1958 patients in a tertiary referral hospital in New South Wales. A logistic regression model was used to examine the association between demographic factors and reasons for discharge delay. Delayed discharge was most commonly associated with the patient's medical conditions, delayed health care or medical consultation, delayed diagnostic services and delayed allied health services. Elderly patients, those living alone and patients from a non-English-speaking background were more likely to have these reasons for delayed discharge.THE INCREASING DEMAND for acute care hospital beds and a push for cost cutting requires efficient discharge planning. [1][2][3][4] Delayed discharge has become a major issue because it leads to unanticipated length of stay and bed block. 2,[5][6][7] Both the quality and cost-effectiveness of care may be compromised as a result. 3,8 In the Australian context, delayed discharge is a major reason for the unavailability of beds in major acute care hospitals. 4 Recent studies suggest a range of reasons for discharge delays. Generically, the reasons for discharge delay include medical issues, hospital factors, patient and carer needs, and issues related to accessing alternative care or social care. The more detailed reasons include complication of the patient medical condition, delay in receiving diagnostic services or results of investigations, transfer delays, a lack of rehabilitation places, awaiting home care, community packages or community services and patient-related factors. 1,2,7 However, the studies exploring the reasons for delayed discharges often had small sample sizes, or were studies examining selected patient populations or a particular ward in a hospital. Very few studies have comprehensively addressed the multifaceted problems of discharge delays in a heterogeneous acute patient population. What is known about the topic? Delayed discharge has become a major issue because it leads to unanticipated length of stay and bed block, reducing patient access. What does this paper add?The reasons for delayed discharge were complex and associated with patients' demographic characteristics and clinical management processes. What are the implications for practitioners?Patients from a non-English-speaking background and unmarried patients were likely to encounter more problems. Elderly patients and the patients with chronic health problems were more likely to experience difficulties in accessing alternative care. These groups need more attention in order to achieve timely discharge from acute care.

The Economic Cost of Bereavement in Scotland

“…, in their Danish population study, also found people who were bereaved of their spouse due to cancer were at greater risk of general or psychiatric hospitalisation in the year post bereavement than non-bereaved matched controls. That people who are bereaved of their spouse remain in hospital longer than non bereaved counterparts, as our study shows, may indicate difficulties associated with complex health and social care needs and living alone (Ou et al, 2009). …”

Factors associated with prolonged length of stay in older patients

“…(6,33) Patient transfers to ILTC institutions may be delayed due to limited bed availability and administrative delays in the referral process. It is hoped that, as ILTC bed capacities increase in the foreseeable future, (34) the bed crunch situation in hospitals will be eased.…”

Access block and emergency department overcrowding

“…When bed occupancy rates are reduced, patient flow improves by allowing patient transfer to the wards, which, in turn, frees up EDs, so that patients from the waiting room or ambulance bay can be seen and processed, reducing ED length of stay, ambulance diversion and operating room cancellations [20,46-48]. …”

“…The reasons for some patient groups being more affected by access block are multifactorial and complex. Deleterious effects as a result of over-crowding and access block have been found in trauma patients [39], and include: Increased delays in transfer to ICU [46-48]; delays in pain treatment [6,7]; increased numbers of patients who did not wait for treatment [36]; increase in patient adverse events [37]; and increased mortality [38,39]. …”