Abstract
BackgroundAcute hospital discharge delays are a pressing concern for many health care administrators. In Canada, a delayed discharge is defined by the alternate level of care (ALC) construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This study examines which characteristics drive acute ALC length of stay for those awaiting nursing home admission.MethodsPopulation-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days.ResultsALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27 day mean deviation, 99% CI = ±14.6), psychiatric diagnosis (13 day mean deviation, 99% CI = ±6.2), abusive behaviours (12 day mean deviation, 99% CI = ±10.7), and stroke (7 day mean deviation, 99% CI = ±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1st 2009 and April 1st, 2011. ALC patients with the identified characteristics had unique clinical profiles.ConclusionsA small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this investigation to maximize effectiveness. Specifically, incentives should be introduced to encourage nursing homes to accept acute patients with the least prospect for community-based living, while acute patients with the greatest prospect for community-based living are discharged to transitional care or directly to community-based care.
Highlights
Acute hospital discharge delays are a pressing concern for many health care administrators
Patients designated alternate level of care (ALC) and discharged between April 1st 2009 and April 1st 2011 had a mean age of 77.1 years, where 15.5% were under age 50 and 0.2% were under age 20
ALC patients waiting for nursing home admission between April 1st 2009 and April 1st 2011 had a mean age of 81.2 years, where 7.4% were under the age of 65, 1.1% were under the age of 50, and none were under 30 years old
Summary
Acute hospital discharge delays are a pressing concern for many health care administrators. Delays in discharge from acute hospitals are a critical challenge for many health care systems in industrialized nations. These delayed discharges are hospital episodes where a patient exceeds the length of stay deemed medically necessary. They are commonly associated with, the health care system, they are best understood as a reflection of the underlying mismatch between the needs of patients and their access to appropriate health care services [12,13,14]. In Canada, acute patients with a delayed discharge are commonly referred to as “alternate level of care” (ALC) patients. A patient that occupies an acute care bed for over a day whilst designated ALC is referred to as an ‘ALC patient’ [25,26,27,28]
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