Improving patient flow: ethnicity and socio-economic status associated with delayed discharge from hospital in patients with COVID-19 infection: An observational epidemiological study

Background: Understanding the reasons for delays in leaving hospital once an in-patient is considered ready for discharge is important to inform the development of interventions to improve patient flow through resource-stressed healthcare systems. Aims: To identify risk factors for delayed discharge from hospital during the COVID-19 pandemic. Methods: The study population was all patients admitted with COVID-19 infection from February 2020 to September 2021 to a large UK teaching hospital. Results: Data were available from 7929 admission events with a median delay of 0.20 days from being considered medically safe for discharge and the discharge date. Age older than 60 years (+2.23 days), White ethnicity (+1.58 days compared to SE Asian), living in an area of increased affluence (+0.13 days per decile decrease in deprivation) and having two or more comorbidities (+1.82 days; compared to no comorbidities) were associated with delayed discharge. There was a total potential saving of over 22,000 bed-days if all patients had been discharged when they were considered medically safe. Conclusions: Early identification of patients at an increased risk of a delayed discharge may allow development of appropriate anticipatory interventions, and inform policymakers to help identify and minimise bottlenecks at the institutional level.