2024 Media Post

Discharge Delays – IHS

Published: October 30, 2024

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Waiting on Post-Acute Placement

The number of patients who are ready for discharge from the hospital but are waiting on a post-acute facility is growing. Patients who are functional dependent requiring additional care in a post-acute facility account for the majority of these discharge delays. This is a prevalent problem across hospitals in many countries including Canada [3], the United States [2, 4], and England [5]

Frequently, patients no longer meet medical necessity for hospitalization, yet their discharge is delayed while they await post-acute care. Delayed discharges have serious implications on healthcare costs. According to the 2020 Health Service Executive Performance report, delayed transfer to a post-acute facility was noted in 11.6% of patients with complex needs. Furthermore, 5.2% of patients had rehabilitation needs leading to delays in the transfer of care. https://www.mdpi.com/2227-9032/11/4/627.

Cost Implications

BMC Health Services Research conducted a retrospective study comparing complications and hospital costs for general medicine patients needing a post-acute facility and those that did not. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4760-3.  

Of 4311 admissions, 255 (6%) patients needing a post-acute facility had a significantly longer length of stay compared to those patients that discharged home. Additionally, hospital costs had a median cost of ($22,459 vs. $5003 p < 0.0001).  

 

Quality Implications

There is a substantial impact on patient safety, quality of care as well as health system utilization and costs when a patient’s discharge is delayed. Prolonged length of stay for these patients increases the risk of accelerated functional decline, delirium, nosocomial infections and falls [8,9,10,11,12]. Furthermore, patients with longer length of stays had more hospital complications (25.5% vs. 5.3% p < 0.0001), particularly nosocomial infections (14.1% vs. 1.9% p < 0.0001), including pneumonia, urinary tract infection, Clostridioides difficile colitis and sepsis.
Aspiration, pulmonary embolism, acute decompensated heart failure, acute kidney injury, pressure ulcer, traumatic fractures, and adverse drug effects were also attributed to prolonged hospital stays.  Additionally, unnecessary hospital days also contributes to patient and family stress [15, 16].

Access to Care

Delays in discharges create hospital bottlenecks impacting patient access to necessary care. Many hospitals are experiencing diversion and emergency department boarding. Additionally, hospitals and health systems are responsible for the high cost of keeping the patient in the acute care setting when their care could be better provided in an alternate level of care.
Consistent with previous health economic studies, the increased costs associated with discharge delays remains high. These costs include discharge delays for patients occupying beds a hospital bed who no longer meet medical necessity, delays in hospital admissions due to bed capacity issues, and nursing and administration costs [1].

Strategies to Minimize Discharge Delays

 “Interventions that minimize delays in discharge may decrease hospital costs and prevent hospital complications.” Integrative Healthcare Solutions has proven success in decreasing hospital discharge delays and reducing associated costs and complications. https://integrative-healthcare-solutions.com/why-choose-integrative-healthcare-solutions/

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