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A long wait: barriers to discharge for long length of stay patients
  1. Emma Jane Zhao1,
  2. Apurva Yeluru2,
  3. Lakshman Manjunath2,
  4. Lei Ray Zhong3,
  5. Hsiao-Tieh Hsu4,
  6. Charles K Lee1,
  7. Anny C Wong1,
  8. Matthew Abramian5,
  9. Haley Manella6,
  10. David Svec2,
  11. Lisa Shieh2
  1. 1 School of Medicine, Stanford University, Stanford, California, USA
  2. 2 Department of Medicine, Stanford University, Stanford, California, USA
  3. 3 Department of Neurosurgery, Stanford University, Stanford, California, USA
  4. 4 Department of Chemistry, Stanford University, Stanford, California, USA
  5. 5 Cancer Clinical Trials Office, Stanford University, Stanford, California, USA
  6. 6 Department of Emergency Medicine, Stanford University, Stanford, California, USA
  1. Correspondence to Emma Jane Zhao, Stanford University, School of Medicine, Stanford, California 94305, USA; ejzhao{at}stanford.edu

Abstract

Introduction Reducing long length of stay (LLOS, or inpatient stays lasting over 30 days) is an important way for hospitals to improve cost efficiency, bed availability and health outcomes. Discharge delays can cost hundreds to thousands of dollars per patient, and LLOS represents a burden on bed availability for other potential patients. However, most research studies investigating discharge barriers are not LLOS-specific. Of those that do, nearly all are limited by further patient subpopulation focus or small sample size. To our knowledge, our study is the first to describe LLOS discharge barriers in an entire Department of Medicine.

Methods We conducted a chart review of 172 LLOS patients in the Department of Medicine at an academic tertiary care hospital and quantified the most frequent causes of delay as well as factors causing the greatest amount of delay time. We also interviewed healthcare staff for their perceptions on barriers to discharge.

Results Discharge site coordination was the most frequent cause of delay, affecting 56% of patients and accounting for 80% of total non-medical postponement days. Goals of care issues and establishment of follow-up care were the next most frequent contributors to delay.

Conclusion Together with perspectives from interviewed staff, these results highlight multiple different areas of opportunity for reducing LLOS and maximising the care capacity of inpatient hospitals.

  • quality in health care
  • general medicine (see Internal Medicine)
  • internal medicine

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Footnotes

  • Contributors EJZ conducted interviews, analyzed results, and was the primary author of this manuscript. AY conducted chart review, analyzed results, and was a secondary author of the manuscript. LM conducted chart review, analyzed results, and edited the manuscript. LRZ planned the study, oversaw interviews and data collection, and edited the manuscript. HH planned the study, oversaw interviews and data collection, and edited the manuscript. CKL conducted chart review, analyzed results, and edited the manuscript. ACW conducted interviews, analyzed results, co wrote Table 3, and edited the manuscript. MA conducted interviews, analyzed results, co-wrote Table 3, and edited the manuscript. HM conducted interviews, analyzed results, and edited the manuscript. DS planned the study, conducted chart review, and edited the manuscript. LS planned the study and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Our study was submitted to Stanford's Institutional Review Board and was determined not to meet the criteria for human subject research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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