Reasons for discharge delays in teaching hospitals.

Soraia Aparecida Da Silva,Carlos Faria Santos Amaral,Flávia Carvalho Botelho,Reginaldo Aparecido Valácio

doi:10.1590/s0034-8910.2014048004971

Soraia Aparecida Da Silva, Carlos Faria Santos Amaral + Show 2 more

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https://doi.org/10.1590/s0034-8910.2014048004971

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Abstract

OBJECTIVETo analyze the causes of delay in hospital discharge of patients admitted to internal medicine wards.METHODSWe reviewed 395 medical records of consecutive patients admitted to internal medicine wards of two public teaching hospitals: Hospital das Clínicas of the Universidade Federal de Minas Gerais and Hospital Odilon Behrens. The Appropriateness Evaluation Protocol was used to define the moment at which notes in the medical records indicated hospital stay was no longer appropriate and patients could be discharged. The interval between this estimated time and actual discharge was defined as the total number of days of delay in hospital discharge. An instrument was used to systematically categorize reasons for delay in hospital discharge and frequencies were analyzed.RESULTSDelays in discharge occurred in 60.0% of 207 hospital admissions in the Hospital das Clínicas and in 58.0% of 188 hospital admissions in the Hospital Odilon Behrens. Mean delay per patient was 4.5 days in the former and 4.1 days in the latter, corresponding to 23.0% and 28.0% of occupancy rates in each hospital, respectively. The main reasons for delay in the two hospitals were, respectively, waiting for complementary tests (30.6% versus 34.7%) or for results of performed tests to be released (22.4% versus 11.9%) and medical-related accountability (36.2% versus 26.1%) which comprised delays in discussing the clinical case and in clinical decision making and difficulties in providing specialized consultation (20.4% versus 9.1%).CONCLUSIONSBoth hospitals showed a high percentage of delay in hospital discharge. The delays were mainly related to processes that could be improved by interventions by care teams and managers. The impact on mean length of stay and hospital occupancy rates was significant and troubling in a scenario of relative shortage of beds and long waiting lists for hospital admission.

Highlights

Remaining in hospital beyond the necessary time has long been a concern, contributing, as it does, to reduced care quality and increased costs.[13]
Both hospitals showed a high percentage of delay in hospital discharge
Delays in hospital discharge (HD) occur in the majority of hospitals.[2,4,17]

Summary

Introduction

Remaining in hospital beyond the necessary time has long been a concern, contributing, as it does, to reduced care quality and increased costs.[13] keeping the user within the health care system keeps them away from family and community life, as well as exposing them to avoidable risks such as hospital infection, depression, loss of physical conditioning, deep vein thrombosis and falls. Concern with the costs resulting from inappropriate use of hospital beds designated for acute care appeared at the end of the last century.[25] A study in 199116 showed an increase in hospital stays in Canada and in the United States, attributed to the growing number of chronic patients dependent on non-hospital care occupying beds that should have been used for the care of acute patients. Changes in work processes may result in decreased HD delays, with no need for financial investments in structure.[5]

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