Factors Associated with Bed-Blocking at a University Hospital (Cantabria, Spain) between 2007 and 2015: A Retrospective Observational Study

Abstract

Current studies on bed-blocking or delayed discharge for non-medical reasons report important variations depending on the country or setting under study. Research on this subject is clearly important as the current system reveals major inefficiencies. Although there is some agreement on the patient-related factors that contribute to the phenomenon, such as older age or a lack of functional ability, there is greater variability regarding environmental or organizational factors. This study sought to quantify the number of cases and days inappropriately spent in hospital and identify patient characteristics and healthcare service use associated with the total length of stay. All cases of delayed discharge were studied at the hospitalization units of a general university hospital in Northern Spain between 2007 and 2015. According to regression estimates, the following characteristics were related to a longer stay: higher complexity through (Diagnosis-Related Group) DRG weight, a diagnosis that implied a lack of functional ability, surgical treatment, having to wait for a destination upon final discharge or return home. After an initial increase, a reduction in delayed discharge was observed, which was maintained for the duration of the study period. Multi-component interventions related with discharge planning can favor a reduced inefficiency with fewer unnecessary stays.

Delayed Discharge for Non-Clinical Reasons in Hip Procedures: Differential Characteristics and Opportunity Cost

“…According to hospital analytical accounting systems data, the mean annual complexity ranged from 1863 to 1949. The increase in the level of complexity is due to the surgical process, additional procedures, and secondary diagnoses quantified in the DRG that increase complexity, which, according to previous studies, is related to a longer hospital stay [4,15,20].…”

“…The descriptive data of the cohort are published elsewhere [4]. A total of 306 patients with HP and delayed discharge for non-clinical reasons were identified during the study period.…”

“…According to our hypothesis, delayed discharge for non-clinical reasons in patients with hip procedures is a relevant problem, representing one of the most prevalent diagnoses in cases of delayed discharge for non-clinical reasons during the 2007-2015 study period and with a high impact on the efficient use of the acute hospitalization ward. Hipprocedures and the musculoskeletal category, in general, were the most relevant in delayed discharge, together with stroke or other nervous system diagnoses [4].…”

“…The prevalence of this problem varies significantly across studies, depending on the context, ranging from 1.6% to 91.3%, with a mean of 22.8%, and affecting all types of health systems, including public health systems and those that are mainly funded by private insurance [2]. Compared to continuous monitoring in other regions of Europe such as the United Kingdom, where reports suggest up to 8.5% number of stays affected by delayed discharge [3], studies on this problem are scarce in Spain, with a recent study by our own research team finding 0.93% of cases out of the total number of discharges in a hospital of high complexity [4].…”

Improving the Use of Healthcare Resources in Canadian Hospitals: The Impact of a Reintegration Unit in Expanding Acute Care Capacity and Resource Use in Sunnybrook Health Sciences Centre

“…ALC patients occupying hospital beds are a contributor to hospital crowding and inappropriate use of limited acute beds. Eliminating "hallway medicine" is a healthcare priority in Ontario, Canada [4] and a concern in many other jurisdictions, including Spain [5], Finland [6], the United Kingdom [7], and elsewhere. Identifying costeffective solutions that reduce current ALC levels would address a critical strategic issue facing healthcare decision makers in many healthcare systems.…”