Hospitalized After Medical Readiness for Discharge: A Multidisciplinary Quality Improvement Initiative to Identify Discharge Barriers in General Medicine Patients. (January 2020)

• Record Type: Journal Article
• Authors: Meo, Nicholas; Liao, Joshua M.; Reddy, Ashok
• Is Part Of: American journal of medical quality. Volume 35:Number 1(2020)
• Page Start: 23
• Page End: 28
• Publication Date: 2020-01
• Subjects: hospital medicine -- resource stewardship -- quality improvement -- multidisciplinary; Medical care -- Quality control -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical care -- Utilization review -- Periodicals; Medical care -- United States -- Periodicals; 362.1
• DOI: 10.1177/1062860619846559
• Languages: English
• ISSNs: 1062-8606

Abstract

Reducing the length of hospitalization is a shared priority for patients, clinicians, and other health care stakeholders. However, patients can remain hospitalized after being "medically ready" for discharge, accumulating delayed discharge bed days (DDBDs). As part of a quality improvement initiative, the authors developed a method to measure DDBD and define discrete barriers to discharge identified by inpatient clinicians. Patients with delayed discharge had a higher rate of in-hospital complications compared to those who were discharged routinely. To identify modifiable barriers among patients with delayed discharges, 2 patient subgroups were defined: prolonged hospitalization (>19 DDBDs, top quintile accumulated) and extended hospitalization (≤19 DDBDs). Patients with prolonged hospitalization were more likely than those with extended hospitalization to have financial ( P < .001) or behavioral ( P < .001) barriers, homelessness ( P < .05), and impairment of decision-making capacity ( P < .01). Understanding the characteristics and discharge barriers of patients who are hospitalized despite medical readiness may increase appropriateness of inpatient resources.