Leaving the hospital on time: hospital bed utilization and reasons for discharge delay in the Netherlands

Abstract

Background Inappropriate bed occupancy due to delayed hospital discharge affects both physical and psychological wellbeing in patients and can disrupt patient flow. The Dutch healthcare system is facing ongoing pressure, especially during the current COVID-19 pandemic, intensifying the need for optimal use of hospital beds. The aim of this study was to quantify inappropriate patient stays and describe the underlying reasons for the delays in discharge. Methods The Day of Care Survey (DoCS) is a validated tool used to gain information about appropriate and inappropriate bed occupancy in hospitals. Between February 2019 and January 2021, the DoCS survey was performed five times in three different hospitals within the region of Amsterdam, the Netherlands. All inpatients were screened, using standardized criteria, for their need for in-hospital care at the time of survey and reasons for discharge delay. Results A total of 782 inpatients were surveyed. Of these patients, 94 (12%) were planned for definite discharge that day. Of all other patients, 145 (21%, ranging from 14% to 35%) were without need for acute in-hospital care. In 74% (107/145) of patients, the reason for discharge delay was outside the hospital; most frequently due to a shortage of available places in care homes (26%, 37/145). The most frequent reason for discharge delay inside the hospital was patients awaiting a decision or review by the treating physician (14%, 20/145). Patients who did not meet criteria for hospital stay were, in general, older (median 75; IQR 65 to 84 years, and 67; IQR 55 to 75 years respectively, p<0.001) and had spent more days in hospital (7; IQR 5 to 14 days and 3; IQR 1 to 8 days respectively, p<0.001). Conclusion Approximately one in five admitted patients occupying hospital beds did not meet the criteria for acute in-hospital stay or care at the time of the survey. Most delays were related to issues outside the immediate control of the hospital. Improvement programs working with stakeholders focusing on the transfer from hospital to outside areas of care need to be further developed and may offer potential for the greatest gain. The Day of Care Survey can be a tool to periodically monitor changes and improvements in patient flow.