Discharge Delay Research Articles

Measuring the Impact of ICU Strain on Mortality, After-Hours Discharge, Discharge Delay, Interhospital Transfer, and Readmission in Australia With the Activity Index.

ICU resource strain leads to adverse patient outcomes. Simple, well-validated measures of ICU strain are lacking. Our objective was to assess whether the "Activity index," an indicator developed during the COVID-19 pandemic, was a valid measure of ICU strain. Retrospective national registry-based cohort study. One hundred seventy-five public and private hospitals in Australia (June 2020 through March 2022). Two hundred seventy-seven thousand seven hundred thirty-seven adult ICU patients. None. Data from the Australian and New Zealand Intensive Care Society Adult Patient Database were matched to the Critical Health Resources Information System. The mean daily Activity index of each ICU (census total of "patients with 1:1 nursing" + "invasive ventilation" + "renal replacement" + "extracorporeal membrane oxygenation" + "active COVID-19," divided by total staffed ICU beds) during the patient's stay in the ICU was calculated. Patients were categorized as being in the ICU during very quiet (Activity index < 0.1), quiet (0.1 to < 0.6), intermediate (0.6 to < 1.1), busy (1.1 to < 1.6), or very busy time-periods (≥ 1.6). The primary outcome was in-hospital mortality. Secondary outcomes included after-hours discharge from the ICU, readmission to the ICU, interhospital transfer to another ICU, and delay in discharge from the ICU. Median Activity index was 0.87 (interquartile range, 0.40-1.24). Nineteen thousand one hundred seventy-seven patients died (6.9%). In-hospital mortality ranged from 2.4% during very quiet to 10.9% during very busy time-periods. After adjusting for confounders, being in an ICU during time-periods with higher Activity indices, was associated with an increased risk of in-hospital mortality (odds ratio [OR], 1.49; 99% CI, 1.38-1.60), after-hours discharge (OR, 1.27; 99% CI, 1.21-1.34), readmission (OR, 1.18; 99% CI, 1.09-1.28), interhospital transfer (OR, 1.92; 99% CI, 1.72-2.15), and less delay in ICU discharge (OR, 0.58; 99% CI, 0.55-0.62): findings consistent with ICU strain. The Activity index is a simple and valid measure that identifies ICUs in which increasing strain leads to progressively worse patient outcomes.

Current trends and possible solutions for delay in patient discharge: observations from a tertiary care paediatric hospital in Mumbai

Delay in discharge of the patient reduces bed availability in any healthcare organization. In spite of advancement in medical systems and hospital management, delay in patient discharges still exist. Hence, there was a need to evaluate factors contributing to the delay in an exclusive paediatric hospital. A study of patient discharges from a private and a general ward was undertaken at a tertiary care paediatric hospital in Mumbai, between September-October 2021. A total of 60 discharges, 30 from each ward were analysed. The time from discharge order given by the consultant to that of the patient leaving the hospital and the reasons for delay were recorded by the investigators. The hospital followed a policy of 180 min for a discharge. The mean duration of discharge in the general ward was 153.18±34.60 min and whereas it was 165.41±62.29 min in the private ward. However, 28% discharges in general ward and 43% discharges in private ward were delayed with a mean of 5.23±10.04 and 20.66±26.88 min respectively. Time taken for billing and making of discharge sheet contributed to the maximum delay in both wards. Though the mean discharge time in both wards was found to be within the standards, a significant proportion were still delayed. We suggest a multidisciplinary team consisting of administrators, nurses, resident doctors and consultants to help ease the overall burden on the healthcare system.

Why am I still in hospital? Evaluation of delayed discharges from two learning disability assessment and treatment units in England

PurposeThis paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line with the transforming care agenda.Design/methodology/approachThis is a retrospective evaluation of 44 admissions and discharges from two ATUs from February 2019 to March 2022.FindingsOf 44 admissions who were discharged during the included period, 20 experienced delays in their discharge. Delayed discharges occurred despite the two ATUs meeting standards for length of assessment and treatment as specified by the Learning Disability Professional Senate. The most prevalent reasons for discharge delays were identification of a new placement, recruitment of care staff and building work.Originality/valueThis paper offers an in-depth evaluation of recent delayed discharges from two regional ATUs, highlighting the most common reasons for delays and offering suggestion for reducing delays in future.

The Impact of the Swedish Care Coordination Act on Hospital Readmission and Length-of-Stay among Multi-Morbid Elderly Patients: A Controlled Interrupted Time Series Analysis.

Coordinating follow-up care after discharge from hospital is critical to ensuring good outcomes for patients, but is difficult when multiple care providers are involved. In 2018, Sweden adopted the Care Coordination Act, which modified economic incentives to reduce discharge delays and mandated a discharge planning process for patients requiring post-discharge social- or primary care services. This study evaluates the impact of this reform on hospital length-of-stay and unplanned readmissions among multi-morbid elderly patients. Interrupted time series analysis of all in-patient care episodes involving multi-morbid elderly patients in Sweden from 2015 - 2019 (n = 2 386 039) was performed. Secondary analyses using case-mix adjustment and controlled interrupted time series analysis were employed to assess for bias. Average length of stay decreased during the post-reform period, corresponding to 248 521 saved care days. Unplanned readmissions meanwhile increased, corresponding to 7 572 excess unplanned readmissions. While reductions in length-of-stay were concentrated among patients targeted by the reform, increases in readmission rates were similar in patients not targeted by the reform, indicating potential confounding. The reform thus appears to have achieved its goal of decreasing in-patient length of stay, but a robust effect on readmissions, outpatient visits, or mortality was not found. This may be due to lackluster implementation or an ineffective mandated intervention.

A STUDY ON DELAY IN INSURANCE PATIENTS DISCHARGE AT A MULTISPECIALITY HOSPITAL IN KERALA

This article discusses the issue of discharge delays in hospitals in Kerala, which can have significant impacts on patients, healthcare providers, and the healthcare system as a whole. The administrative challenges faced by hospitals, including obtaining insurance authorization, completing documentation, coordinating with different departments, and arranging post-hospital care, can be time-consuming and complex. This article identifies the causes of delay in discharge for patients who are funded through insurance and identifies timely allied services to reduce discharge delays. The article presents data collected through a census method for a period of three months, analyzing the time taken for each process involved in the discharge process, including send for billing, pharmacy clearance, bill clearance, bill closing, and discharge. The article finds that the standard Turn Around Time for the discharge process is 5 hours, and 59.4% of the observations exceed the standard TAT. The article recommends streamlining the administrative processes involved in discharge to reduce discharge delays and improve patient care. KEYWORDS: Turn Around Time, Insurance, Discharge, Clearance, Administration.

Discharge delay from the Post Anaesthesia Care Unit: A nursing perspective

Discharge delay from the Post Anaesthesia Care Unit: A nursing perspective

Nonmedical Delays in Discharge (NMDD) Among Emergency General Surgery (EGS) And Trauma Patients: A Prospective Assessment of Social Determinants of Health (SDOH) And Civil Legal Needs (CLN)

Bathan, Karen; DePolo, Nicole MD; Tran, Zachary MD; Peng, Jiahao MD, MPH; Singh, Pramil DrPh; Srikureja, Daniel P MD, FACS; Yung, Wing Sze Esther MD, FACS Author Information

Leaving the hospital on time: hospital bed utilization and reasons for discharge delay in the Netherlands.

Inappropriate bed occupancy due to delayed hospital discharge affects both physical and psychological well-being in patients and can disrupt patient flow. The Dutch healthcare system is facing ongoing pressure, especially during the current coronavirus disease pandemic, intensifying the need for optimal use of hospital beds. The aim of this study was to quantify inappropriate patient stays and describe the underlying reasons for the delays in discharge. The Day of Care Survey (DoCS) is a validated tool used to gain information about appropriate and inappropriate bed occupancy in hospitals. Between February 2019 and January 2021, the DoCS was performed five times in three different hospitals within the region of Amsterdam, the Netherlands. All inpatients were screened, using standardized criteria, for their need for in-hospital care at the time of survey and reasons for discharge delay. A total of 782 inpatients were surveyed. Of these patients, 94 (12%) were planned for definite discharge that day. Of all other patients, 145 (21%, ranging from 14% to 35%) were without the need for acute in-hospital care. In 74% (107/145) of patients, the reason for discharge delay was due to issues outside the hospital; most frequently due to a shortage of available places in care homes (26%, 37/145). The most frequent reason for discharge delay inside the hospital was patients awaiting a decision or review by the treating physician (14%, 20/145). Patients who did not meet the criteria for hospital stay were, in general, older [median 75, interquartile range (IQR) 65-84 years, and 67, IQR 55-75 years, respectively, P < .001] and had spent more days in hospital (7, IQR 5-14 days, and 3, IQR 1-8 days respectively, P < .001). Approximately one in five admitted patients occupying hospital beds did not meet the criteria for acute in-hospital stay or care at the time of the survey. Most delays were related to issues outside the immediate control of the hospital. Improvement programmes working with stakeholders focusing on the transfer from hospital to outside areas of care need to be further developed and may offer potential for the greatest gain. The DoCS can be a tool to periodically monitor changes and improvements in patient flow.

Elective intubation for laser retinopexy treatment of severe ROP is not associated with increased morbidity or length of stay.

Laser retinopexy is the current standard treatment for babies with type I retinopathy of prematurity (ROP). No guidelines exist for respiratory management during this procedure. Although neonatologists prefer to avoid intubation to prevent delays in extubation, feeding and discharge, ophthalmologists often request intubation, because sedation alone may lead to respiratory collapse. Little evidence is available regarding which treatment provides the most benefit to vulnerable infants. This study investigated relevant associations or underlying conditions that may help guide decision-making in respiratory management during laser retinopexy. A retrospective chart review was performed to analyze data from babies who underwent retinopexy from 2006 to 2011 at the Montefiore Medical Center. The main outcome measures included respiratory support before, during and after laser therapy; time from treatment to extubation; and time from treatment to discharge. The main outcomes were analyzed in four groups: never intubated (n = 27), emergently intubated (n = 7), already intubated (n = 8) and electively intubated (n = 28). No significant differences were observed in the number of pre-operative apneic/bradycardic events, postoperative time to extubation, time to discharge and delays in feeding among groups. No specific comorbid conditions were found to predict a need for intubation. Elective intubation did not cause delays in feedings, extubation or discharge. A selective approach to respiratory support would result in 20% of initially non-intubated patients requiring emergent intubation.

Hospital Boarding Crises: The Impact of Urgent vs. Prevention Responses on Length of Stay

Healthcare policy makers use wait-time metrics to encourage hospital managers to improve patient experience. In 2002, Massachusetts mandated that hospital managers develop processes to respond to boarding crises, which occur when emergency department (ED) patients experience long waits for inpatient beds. Performance improvement theory suggests that patients would be better served by preventing boarding crises rather than responding urgently after they occur. To empirically test this theory, we use data from a Massachusetts hospital that has two physician-based processes related to boarding and patient flow. First, to comply with the state mandate, the hospital developed processes to identify when the hospital is in a boarding crisis, a code yellow (CY), and subsequently request that physicians prioritize patient discharge (urgent response). Second, physicians can use predischarge orders, optional written communication about discharge barriers, to avoid discharge delays for patients approaching discharge (prevention response). Our data supports the existence of a trade-off between these two responses. Counter to our hypothesis, the state-mandated urgent response does not have any impact on length of stay (LOS). We also find that a CY has no impact on ED hourly occupancy, marginally decreases ED wait times, and increases boarding time. The prevention response is associated with a 26% reduction in LOS. Furthermore, we find that the urgent response reduces the likelihood of physicians’ ability to use the prevention response by 27.3%. We conclude that the state policy has unintended negative consequences that stymie hospital efforts to create longer term improvement. This paper was accepted by Stefan Scholtes, healthcare management. Supplemental Material: The online appendix and data are available at https://doi.org/10.1287/mnsc.2023.4724 .

Identification of Risk Factors Contributing to Prolonged Stay in the Post-anaesthesia Care Unit at a Tertiary Care Hospital in Abu Dhabi, United Arab Emirates.

Post-anesthesia care units (PACU) were developed to reduce postoperative morbidity and mortality and the ideal duration of postoperative stay has been proposed as two hours; however, the incidence and risk factors for prolonged stay are variable.The objective of this study was to assess the incidence of prolonged length of stay in the post-anesthesia care unit at Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates, and identify the risk factors contributing to it. This is a retrospective observational study of patients who stayed in the PACU for more than two hours. A total of 2387 patients, both male and female, who underwent surgical procedures between May 2022 to August 2022 at SKMC and were admitted to the PACU after surgery were included in the study and their data were analyzed. Of the 2387 patients who underwent surgical procedures, 43 (1.8%) had prolonged stays in the PACU. Of these, 20 (47%) were adult cases and 23 (53%) were pediatric cases. The main reasons for the delay in discharge from PACU in our study were the non-availability of ward beds (25.5%), followed by pain management (18.6%). We recommend improving the communication between different specialties, restructuring staffing, implementing changes in perioperative management, and changing operating room scheduling to prevent avoidable reasons contributing to a prolonged stay in the PACU.

Discharge Delay: How Can We Help Ourselves, Patients, and Families.

Discharge delays are frustrating to patients, staff, and families. Case managers need a better understanding of what type of patient may experience a discharge delay so they can better prepare patients and families or avoid the discharge delay before it happens. Hospital. Discharge delays are exasperating to all involved, as they take up precious time and resources of case managers and make patients and families feel like there is an unclear plan. There are actions a case manager can take to lessen the burden of a discharge delay. Actions such as having a rapid discharge plan once the home environment is deemed inappropriate and making sure families and patients are communicated with frequently about their plan of care can decrease or avoid a discharge delay. Case managers need to know how to identify a patient who might experience a delay in their discharge early, so they can assist the patient and family to ease their stress by explaining limitations and realistic timelines. By identifying a patient who will be experiencing a delay in their discharge due to postacute lack of staffing, care managers can alert families that finding other options for discharge might be more satisfactory. By screening a patient and identifying their needs early, a discharge delay can be shortened or avoided.

ChatGPT: the future of discharge summaries?

ChatGPT: the future of discharge summaries?

Avoidable Discharge Delays: Children Waiting in Hospitals Deserve More Attention.

Avoidable Discharge Delays: Children Waiting in Hospitals Deserve More Attention.

Time-to-Event Analysis of Factors Influencing Delay in Discharge from a Subacute Complex Discharge Unit during the First Year of the Pandemic (2020) in an Irish Tertiary Centre Hospital.

Our study aimed to analyse delaying factors amongst patients with a length of stay (LOS) > 15 days during the COVID-19 pandemic using time-to-event analysis. A total of 390 patients were admitted between March 2020-February 2021 to the subacute complex discharge unit in St James's Hospital: 326 (83.6%) were >65 years of age and 233 (59.7%) were female. The median (IQR) age was 79 (70-86) years with a median (IQR) of 19.4 (10-41) days. A total of 237 (60.7%) events were uncensored, with LOS > 15 days, of which 138 (58.2%) were female and 124 (52.32%) had >4 comorbidities; 153 (39.2%) were censored into LOS ≤ 15 days, and death occurred in 19 (4.8%). Kaplan-Meier's plot compared factors causing a delay in discharge to the single factors: age, gender, and multimorbidity. A multivariate Cox regression analysis adjusted to age, gender, and multimorbidity predicted factors affecting LOS. Further research is required to explore multimorbidity as a risk factor for mortality in patients with prolonged LOS within a complex discharge unit and target gender-specific frailty measures to achieve high-quality patient management.

Inhalation Anesthetics for Postoperative Nausea and Vomiting in General Anesthesia Patients

Background: Postoperative nausea and vomiting is an anesthetic complication which is related to various factors. Patients who experience postoperative nausea and vomiting have worse quality of recovery which causes delay in patient discharge from the hospital which will increase the cost of care. Objective: To knowing the effect of inhalation anesthetics on postoperative nausea and vomiting in general anesthesia patients at Dr Soedirman Hospital Kebumen. Method: The study is a quasi-experimental quantitative study with a pre-test-post-test design with a control group design. The population of the study were all patients undergoing general anesthesia at Dr Soedirman Hospital Kebumen. The study was conducted in September - October 2022 with a sample of 56 respondents for each group which was determined using a purposive sampling technique. Data analysis using the Wilcoxon test. Result: Results of analysis of the effect of inhalational anesthesia on postoperative nausea and vomiting in general anesthesia patients at Dr Soedirman Hospital Kebumenp (sig) 0.000. Conclusion: There is an effect of inhalation anesthetics on postoperative nausea and vomiting in general anesthesia patients&#x0D;

Spine

The February 2023 Spine Roundup360 looks at: S2AI screws: At what cost?; Just how good is spinal deformity surgery?; Is 80 years of age too late in the day for spine surgery?; Factors affecting the accuracy of pedicle screw placement in robot-assisted surgery; Factors causing delay in discharge in patients eligible for ambulatory lumbar fusion surgery; Anterior cervical discectomy or fusion and selective laminoplasty for cervical spondylotic myelopathy; Surgery for cervical radiculopathy: what is the complication burden?; Hypercholesterolemia and neck pain; Return to work after surgery for cervical radiculopathy: a nationwide registry-based observational study.

Care of the Hospitalized Patients with Kidney Failure during COVID-19 Pandemic: Lessons Learned.

Care of the Hospitalized Patients with Kidney Failure during COVID-19 Pandemic: Lessons Learned.

Prevalence and predictors of prolonged length of stay among patients admitted under general internal medicine in a tertiary government hospital in Manila, Philippines: a retrospective cross-sectional study

BackgroundProlonged hospitalization leads to poorer health outcomes and consumes limited hospital resources. This study identified factors associated with prolonged length of stay (PLOS) among internal medicine patients admitted in a tertiary government hospital.MethodsWe reviewed the medical records of 386 adult patients admitted under the primary service of General Internal Medicine at the Philippine General Hospital from January 1 to December 31, 2019. PLOS was defined as at least 14 days for emergency admissions or 3 days for elective admissions. Sociodemographics, clinical characteristics, admission- and hospital system-related factors, disease-specific factors, outcome on the last day of hospitalization, and hospitalization costs were obtained. We determined the proportion with PLOS and reviewed reasons for discharge delays. We conducted multiple logistic regression analyses to assess associations between various factors and PLOS.ResultsThe prevalence of PLOS is 19.17% (95% CI 15.54, 23.42). Positive predictors include being partially dependent on admission (aOR 2.61, 95% CI 0.99, 6.86), more co-managing services (aOR 1.26, 95% CI 1.06, 1.50), and longer duration of intravenous antibiotics (aOR 1.36, 95% CI 1.22, 1.51). The only negative predictor is the need for intravenous antibiotics (aOR 0.14, 95% CI 0.04, 0.54). The most common reason for discharge delays was prolonged treatment. The median hospitalization cost of patients with PLOS was PHP 77,427.20 (IQR 102,596).ConclusionsAlmost a fifth of emergency admissions and a quarter of elective admissions had PLOS. Addressing factors related to predictors such as functional status on admission, number of co-managing services, and use of intravenous antibiotics can guide clinical and administrative decisions, including careful attention to vulnerable patients and judicious use of resources.

Hospital Boarding Crises: The Impact of Urgent Versus Prevention Responses on Length of Stay

Healthcare policymakers use wait-time metrics to encourage hospital managers to improve patient experience. In 2002, Massachusetts mandated that hospital managers develop processes to respond to boarding crises, which occur when emergency department (ED) patients experience long waits for inpatient beds. Performance improvement theory suggests that patients would be better served by preventing boarding crises rather than responding urgently after they occur. To empirically test this theory, we use data from a Massachusetts hospital that has two physician-based processes related to boarding and patient flow. First, to comply with the state mandate, the hospital developed processes to identify when the hospital is in a boarding crisis, a code yellow (CY), and subsequently request that physicians prioritize patient discharge (urgent response). Second, physicians can use pre-discharge orders (PDO), optional written communication about discharge barriers, to avoid discharge delays for patients approaching discharge (prevention response). Our data support the existence of a tradeoff between these two responses. Counter to our hypothesis, the state-mandated urgent response does not have any impact on LOS. We also find that a CY has no impact on ED hourly occupancy, marginally decreases ED wait times, and increases boarding time. The prevention response is associated with a 26% reduction in LOS. Furthermore, we find that the urgent response reduces the likelihood of physicians’ ability to use the prevention response by 27.3%. We conclude that the state policy has unintended negative consequences that stymie hospital efforts to create longer-term improvement.