71 Challenges of Delayed Discharges – A Rehabilitation Hospital’s Perspective

Abstract

Abstract Background Delayed discharge is a system level problem. It is prevalent internationally, expensive and associated with detrimental outcomes for both patients and health care staff. The aim of this study was to examine reasons for delayed discharges and investigate the relationship between it and clinical complications in a rehabilitation unit. Methods A retrospective study design of patients on delayed discharge list, from December 2017 to August 2018. Data collected from review of medical charts and electronic patient records (BlueSpier). Results 62 patients were identified as delayed discharges, representing 33.3% of the total 186 discharges from the ward, over a 9-month period. Data was obtained for 27 patients. Mean age was 82 years (66-96 years) with an equal male: female ratio. Mean bed days lost was 37 days (4-274 days). 63% of discharges were delayed due to home care packages (HCP), including 44.4% (n=12) awaiting approval of new HCP and the remaining 18.5% (n=5) awaiting an increase in hours. 25.5% (n=7) of delayed patients were awaiting suitable nursing home placements. Other reasons for delayed discharges included awaiting equipment for home (n=5), home adaptations (n=3) and ward of court proceedings (n=1). Morbidities and clinical complications were common among delayed patients. 26% (n=7) became more dependent in mobility at discharge and 51.9% (n=14) experienced clinical complications. These complications include infections (n=9), falls (n=3), acute delirium (n=2), exacerbation of heart failure (n=1), low mood (n=1), acute coronary syndrome (n=1) and pressure sore (n=1). Conclusion 1 in 3 discharges from our rehabilitation ward were delayed. These delays led to functional decline in our patients and exposed them to avoidable adverse outcomes by unnecessary prolonging hospitalisation. Resources need to be directed towards prompt delivery of community services to facilitate a safe and timely hospital discharge.