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Original article
Waiting it out: consultation delays prolong in-patient length of stay
  1. Arifeen Sylvanna Rahman1,
  2. Siyu Shi1,
  3. Pamela Katherine Meza1,
  4. Justin Lee Jia1,
  5. David Svec2,
  6. Lisa Shieh2
  1. 1 School of Medicine, Stanford University, Stanford, California, USA
  2. 2 Department of Medicine, Stanford University, Stanford, California, USA
  1. Correspondence to Arifeen Sylvanna Rahman, School of Medicine, Stanford University, Stanford, CA 94305, USA; arifeenr{at}stanford.edu

Abstract

Background Decreasing delays for hospitalised patients results in improved hospital efficiency, increased quality of care and decreased healthcare expenditures. Delays in subspecialty consultations and procedures can cause increased length of stay due to reasons outside of necessary medical care.

Objective To quantify, describe and record reasons for delays in consultations and procedures for patients on the general medicine wards.

Methodology We conducted weekly audits of all admitted patients on five Internal Medicine teams over 8 weeks. A survey was reviewed with attending physicians and residents on five internal medicine teams to identify patients with a delay due to consultation or procedure, quantify length of delay and record reason for delay.

Results During the study period, 316 patients were reviewed and 48 were identified as experiencing a total of 53 delays due to consultations or procedures. The average delay was 1.8 days for a combined total of 83 days. Top reasons for delays included scheduling, late response to page and a busy service. The frequency in length of consult delays vary among different specialties. The highest frequency of delays was clustered in procedure-heavy specialties.

Conclusion This report highlights the importance of reviewing system barriers that lead to delayed service in hospitals. Addressing these delays could lead to reductions in length of stay for inpatients.

  • length of stay
  • quality improvement
  • consultation delays
  • multi-disciplinary care
  • teamwork

http://dx.doi.org/10.1136/postgradmedj-2018-136269

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    Footnotes

    • Contributors ASR oversaw data collection, collected survey data, analysed results and was the primary author of the manuscript. SS collected survey data, analysed results and was the secondary author of the manuscript. PKM collected survey data and edited the manuscript. JLJ collected data and edited the manuscript. DS planned the study 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 for publication 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; internally peer reviewed.