[Delayed discharge of older patients from the Department of Geriatric Medicine of the Erasmus Medical Centre and factors affecting the length of stay; July 2001--June 2002]

Abstract

Objective: To determine how the discharge of older patients proceeds and what factors affect it.

Design: Descriptive.

Method: Data were collected on the 123 patients admitted to the Department of Geriatric Medicine of the Erasmus Medical Centre in Rotterdam, the Netherlands: retrospectively, from the patient files, for the admissions in the period from 1 July 2001 to 31 March 2002, and prospectively for the admissions between 1 April and 30 June 2002. Key figures in the discharge process were also interviewed during the period from 1 September to 21 November 2002.

Results: The average age was 83.5 years (SD: 7); 34% were males. The average duration of treatment was 13 days while the average length of admission was 22 days. There was an average of 10 days between the request from the Geriatrics Department to discharge from the hospital, via a care office for an additional-care facility, an Aftercare Office and a Regional Indicating Office (RIO). Patient characteristics that were associated with a longer duration of admission and a longer discharge procedure were: discharge to a somatic nursing home, a diagnosis of 'delirium' or 'dementia', and living independently at home before admission. Patients who were known to the Geriatrics Department (either via the outpatient clinic or via a previous admission) had a shorter duration of admission. Of all the indication decisions of the RIO, only one deviated from the recommendation of the Geriatrics Department.

Conclusion: The average duration of admission was 9 days longer than the average duration of treatment. The discharge procedure could be accelerated by simplifying the bureaucratic process surrounding indication and referral to an additional-care facility and by accepting the recommendations of the Geriatrics Department.