Key result
Hospital discharge delays affect ~23% of pediatric inpatients, driven primarily by physician behavior.
Why the study?
Delays in hospital discharges affect efficiency and timeliness of inpatient care, impacting quality measures such as length of stay and costs.
Cohort (n=171)
No
Discharge delays affect nearly a quarter of pediatric inpatients, substantially increasing length of stay and hospital costs.
Discharge delays may substantially increase pediatric hospital resource use; leaves open whether interventions targeting physician behavior reduce delays.
BACKGROUND: Delays in discharges affect both efficiency and timeliness of care; 2 measures of quality of inpatient care. OBJECTIVE: Describe number, length, and type of delays in hospital discharges. Characterize impact of delays on overall length of stay (LOS) and costs. DESIGN: Prospective observational cohort study. SETTING: Tertiary-care children's hospital. PATIENTS: All children on 2 medical teams during August 2004. INTERVENTION: Two research assistants presented detailed data of patient care (from daily rounds) to 2 physicians who identified delays and classified the delay type. Discharge was identified as delayed if there was no medical reason for the patient to be in the hospital on a given day. MEASUREMENTS: Delays were classified using a validated and reliable instrument, the Delay Tool. LOS and costs were extracted from an administrative database. RESULTS: Two teams cared for 171 patients. Mean LOS and costs were 7.3 days (standard deviation [SD] 14.3) and $15,197 (SD 38,395), respectively: 22.8% of patients experienced at least 1 delay, accounting for 82 delay-related hospital days (9% of total hospital days) and $170,000 in costs (8.9% of hospital costs); 42.3% of the delays resulted from physician behavior, 21.8% were related to discharge planning, 14.1% were related to consultation, and 12.8% were related to test scheduling. CONCLUSIONS: Almost one-fourth of patients in this 1-month period could have been discharged sooner than they were. Impact of delays on LOS and costs are substantial. Interventions will need to address variations in physician criteria for discharge, more efficient discharge planning, and timely scheduling of consultation and diagnostic testing.
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Srivastava et al. (2009) conducted a cohort in Pediatric inpatient care (n=171). Delays in hospital discharge was evaluated on Proportion of patients experiencing at least 1 discharge delay. Delays in hospital discharge affected 22.8% of pediatric inpatients, accounting for 9% of total hospital days and 8.9% of hospital costs, primarily driven by physician behavior.
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