Evaluating Factors Contributing to Discharge Delays in a Community Hospital

From the 2021 HVPAA National Conference

Jacob VanHouten (Griffin Hospital), Valentine Njike, Olugbenga Arole

Background

Late afternoon discharges from the general medicine floor affect the hospital efficiency throughout by interfering with the admission of new patients from the emergency department (ED). This leads to an increased length of time in the ED and contributes to ED overcrowding. Overcrowding in the ED creates a significant quality and safety issue. It contributes to ambulances being diverted from the ED and to some patients leaving the ED in frustration without being seen. ED overcrowding also contributes to poor care, of outpatients who visit the ED as there are increased opportunities for error. We evaluated factors contributing to delays in discharges and determined which patients are most likely to benefit from interventions to reduce discharge delays in a community hospital.

Methods

The study was conducted at Griffin Hospital, a 160-bed community hospital in Derby, Connecticut. This was a retrospective analysis of patients discharged from the in-patient service from October through December 2019. Discharge delays were defined as patients whose discharge orders were placed after noon and/or patients who did not leave within two hours of placement of their discharge order. Our inclusion criteria were patients who were admitted to the in-patient medical service and were subsequently discharged during the 3-month review period. We excluded patients who signed out of the hospital against medical advice, who were transferred to another hospital or who expired.

Results

A total of 1249 cases were reviewed. The number of discharges to home without services, to home with services, and to skilled nursing home facilities (SNF) were 589, 476, and 184, respectively. A total of 674 (54.0%) patients had their discharge orders placed before noon. A total of 646 (51.7%) patients left within 2 hours after their discharge orders were placed. The median time from order to discharge was 114 minutes. Patients discharged to home without services were as likely as those discharged to home with services to have their orders placed before noon (n= 325, 55.2% vs n=262, 55.0%, respectively; Χ2=0, p=1.0), but were more likely to leave within two hours of the order being placed (n = 376, 63.8% vs n=214, 45.0%, respectively; Χ2=37.2, p<0.001). Patients going to a SNF were less likely to have their discharge order placed before noon (n=87, 47.3%; ; Χ2=3.2, p=0.07) and less likely to leave within 2 hours of the discharge order (n=56, 30.4%; ; Χ2=62.1, p<0.001) compared to patients discharged home without services.

Conclusions

Our data suggest that a patient’s planned location after discharge plays a significant role in determining if the patient will experience a discharge delay. Patients going to a SNF are more likely to both have their orders placed later and leave the hospital a longer time after the order. This study highlights areas where interventions could be placed to reduce discharge delays. A one-size-fits-all approach may not suffice to address the barriers arising from patient discharge delays.

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