Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study

Abstract

BackgroundHospitalized patients are designated alternate level of care (ALC) when they no longer require hospitalization but discharge is delayed while they await alternate disposition or living arrangements. We assessed hospital costs and complications for general internal medicine (GIM) inpatients who had delayed discharge. In addition, we developed a clinical prediction rule to identify patients at risk for delayed discharge.MethodsWe conducted a retrospective cohort study of consecutive GIM patients admitted between 1 January 2015 and 1 January 2016 at a large tertiary care hospital in Canada. We compared hospital costs and complications between ALC and non-ALC patients. We derived a clinical prediction rule for ALC designation using a logistic regression model and validated its diagnostic properties.ResultsOf 4311 GIM admissions, 255 (6%) patients were designated ALC. Compared to non-ALC patients, ALC patients had longer median length of stay (30.85 vs. 3.95 days p < 0.0001), higher median hospital costs ($22,459 vs. $5003 p < 0.0001) and more complications in hospital (25.5% vs. 5.3% p < 0.0001) especially nosocomial infections (14.1% vs. 1.9% p < 0.0001). Sensitivity analyses using propensity score and pair matching yielded similar results. In a derivation cohort, seven significant risk factors for ALC were identified including age > =80 years, female sex, dementia, diabetes with complications as well as referrals to physiotherapy, occupational therapy and speech language pathology. A clinical prediction rule that assigned each of these predictors 1 point had likelihood ratios for ALC designation of 0.07, 0.25, 0.66, 1.48, 6.07, 17.13 and 21.85 for patients with 0, 1, 2, 3, 4, 5, and 6 points respectively in the validation cohort.ConclusionsDelayed discharge is associated with higher hospital costs and complication rates especially nosocomial infections. A clinical prediction rule can identify patients at risk for delayed discharge.

Delay in Hospital Discharge of Trauma Patients: A Prospective Observational Study

“…In our study, age only correlated weakly with delayed discharge, whereas, in other studies, age was one of the factors that in uenced delayed discharge [9,10]. According to the NHS in Scotland, 69% of delayed discharges occurred in patients 75 years of age and older [6].…”

“…It is to be noted that other factors related to rehabilitation facility arrangements post-discharge were found to be strongly associated with discharge delays in the USA and the UK [5,[8][9][10]18]. Such facilities are not as common in Egypt.…”

“…The National Health Service (NHS) of England experiences approximately £100 m per year in costs associated with delayed discharge [7]. The increased cost of delayed discharged was reported by different studies and was attributed to occupying beds, needing to pay for nursing staff and other administrative costs [8][9][10][11]. In a study done by Thomas S et al in the USA, the total cost of delayed discharge per year was reported to be at about $715,403 [9].…”

“…University hospitals in Egypt have a limited budget and they often provide free services to the public [12,13]. Inappropriate bed use and prolonged stay increase the nancial burden on the health services especially in Egypt, where hospital admissions account for a signi cant amount of total healthcare costs in Egypt [6][7][8][9][10][11][13][14][15]. Therefore, improvements in acute care bed management could result in signi cant savings.…”

Impact of Urgent and Emergency Care Vanguards on Delayed Transfers of Care in England

“…Delayed Transfers of Care (DTOC) is a term used to describe situations where patients are medically fit to be discharged from a hospital to home or further care settings but the process is delayed. DTOC has attracted increased attention from policy makers and health and social care professionals (1), due to recent increases (2), an estimated £820 million annual cost (3), and delayed hospital discharge has been associated with decreased subsequent participation in activities of daily living, frailty, increased age, high comorbidity, cognitive impairment, and dependency (4)(5)(6)(7)(8)(9)(10).…”