Sociodemographic, clinical and organisational factors associated with delayed hospital discharges: a cross-sectional study

Abstract

BackgroundEvidence from studies conducted in Western countries indicates that a significant proportion of hospital beds are occupied by patients who experience a delayed hospital discharge (DHD). However, evidence about this topic is lacking in Italy, and little is known on the patients’ and organisational characteristics that influence DHDs. Therefore, we carried out a survey in all the hospitals of a Northern Italian region to analyse the prevalence and the determinants of DHD.MethodsA cross-sectional study was carried out during an index period of 15 days in 256 operative units in Emilia-Romagna, a Northern Italian region with 4.4 million inhabitants, to identify patients medically fit for discharge but still hospitalised. The characteristics of these patients (n = 510) were compared with all the other patients (n = 5,815) hospitalised in the same operative units during the index period using multilevel logistic regression models.ResultsThe one-day prevalence of DHD was 8.1%. More than half of DHD patients (52.7%) waited to access long-term/rehabilitation units or residential care homes, 16.7% experienced a delay for family-related reasons, and 14.5% were waiting to be admitted to other rehabilitation services. Among DHD patients hospitalised in long-term/rehabilitation units, 45.3% were waiting to be transferred to residential care homes. Patients’ characteristics associated with a higher likelihood of DHD in multilevel logistic regression were older age, provision of intensive care, a diagnosis of dementia, tumours or femoral/shoulder fractures, and a number of comorbidities. Patients hospitalised in long-term/rehabilitation units, as well as in orthopaedics/traumatology units, were significantly more likely to have a DHD compared with patients hospitalised in general surgery units. Moreover, compared with Local Health Authority Hospitals, being hospitalised in Hospital Trusts was associated with a higher likelihood of DHD.ConclusionsAlthough the prevalence of DHD in the present study is markedly lower than that reported in the literature, we submit that the DHD problem should be addressed with major organisational innovations, with a special focus on the ageing of the population and epidemiological trends. Organisational changes imply new ways of managing emerging clusters of patients whose needs are not efficiently or effectively met by traditional organisation models and services.

Factors associated with prolonged length of stay in older patients

“…(13) Among patients with dementia, caregiver support and burden (14) are important predictors of pLOS, just as poor nutritional status (15) is an important predictor for older adults. Expectedly, clinical factors, (16) such as the principal admitting diagnosis and burden of comorbidities, have been shown to be important.…”

Causas de atraso na alta hospitalar no cliente adulto: scoping review

“…Succinctly, the analysis performed found that the delayed hospital discharges relate especially to: community resources, mainly regarding the lack of vacancies in retirement homes and healthcare units, namely in continued care (2)(3)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) and due to social reasons (3,7,9,12,14,17,(19)(20)(21) ; organizational causes related to healthcare, with a greater incidence of waiting for health evaluations, treatments, or exam results (4,7,(14)(15)(17)(18)22) ; individual causes, especially family (7,8,(14)(15)17,21) and financial (7,14,16) issues; and organizational causes related to hospital management, in which case the lack of human resources stands out (7,(14)(15)23) .…”

“…The 22 articles found were published from 2001 to 2016, standing out the years 2006 and 2012, with 3 articles each. Most of them were conducted in the United Kingdom (n=14) (3,4,7,(9)(10)(11)(13)(14)16,18,20,(22)(23)25) , Spain (n=3) (15,17,21) , Italy (n=2) (8,19) , Portugal (n=1) (12) , Norway (n=1) (2) , and Denmark (n=1) (24) . Rev Gaúcha Enferm.…”

“…Cause subtype Organizational Related to healthcare Waiting for health evaluations, treatment, or exam results (4,7,(14)(15)(17)(18)22) Falls (19) Pain management (19) Care during intra-hospital rehabilitation (10,24) Number of procedures undergone (2) Need for bladder catheterization (24)(25) Need for blood transfusions (20,(24)(25) Use of patient-controlled analgesia (25) Discharge preparation (4) Nurse referral (3,9) Professional team mistakes (4,15,17) Healthcare-related infection (3,(19)(20) Regarding the type of study, one (14) was a literature review from the United Kingdom focused on elder clients, and 21 were observational studies, including cross-sectional (2,8,11,18) , prospective cohort (3,4,9,(12)(13)15,17,(19)(20)(21)(22)(23)(24)(25) , and retrospective studies…”

Educational Conference Scheduling, Patient Discharge Time, and Resident Satisfaction

“…There likely are other factors that influence discharge times. Previous studies [7][8][9] have reported that diagnostic testing and/or consultation delays, and lack of discharge planning, commonly affect the time of discharge.…”