Nonmedical Discharge Barriers in Prolonged Stays on a General Medicine Ward: A Retrospective Review

Abstract

Background: Prolonged stays negatively impact patient outcomes and are costly for the healthcare system. Nonmedical barriers to discharge, such as lack of insurance or post-acute care facility acceptances, are increasingly recognized as causes of prolonged stays beyond medical necessity. Methods: A retrospective chart review of patients admitted over a two-year period with stays beyond 30 days on a general medicine floor of an urban academic hospital was conducted. Demographic, clinical and administrative data were recorded. Barriers to discharge were characterized at days 30, 60, and 90 of admission. Nonmedical barriers were recorded for patients who stayed beyond medical readiness for discharge. Results: Out of 2866 admissions, 101 hospitalizations (3.5%) of 97 patients were prolonged, accounting for a total of 6518 (27.2%) of 23,934 inpatient days. Of the prolonged stays, 37 stays lasted longer than 60 days and 17 lasted longer than 90 days. At lengths of stay day 30, 60, and 90, the proportion of admissions that were prolonged beyond medical necessity by nonmedical factors were 36.6%, 59.5%, and 52.9% respectively. The most common nonmedical barrier to discharge at all three timepoints was barriers to facility placement. Conclusions: A small proportion of prolonged stay patients make up a disproportionately high number of inpatient days, with nonmedical factors contributing to more than half of cases beyond 60 days. The rising prevalence of nonmedical barriers, particularly the lack of facility acceptances, highlights the need to examine delays at the systems-level.