Characteristics of patients in a ward of Academic Internal Medicine: implications for medical care, training programmes and research

Abstract

To describe the characteristics of "delayed discharge patients" and the factors associated with "delayed discharges", we performed a 12-month observational study on patients classified as "delayed discharge patients" admitted to an Academic Internal Medicine ward. We assessed the demographic variables, the number and severity of diseases using the Geriatric Index of Comorbidity (GIC), the cognitive, affective and functional status using, respectively, the Mini Mental Stare Examination, the Geriatric Depression Scale and the Barthel Index. We assessed the total length of stay (T-LHS), the total inappropriate length of stay (T-ILHS), the median length of stays (M-LHS), the median inappropriate length of stay (M-ILHS) and evaluated the factors associated with delayed discharge. "Delayed discharge patients" were 11.9% of all patients. The mean age was 81.9 years, 74.0% were in the IV class of GIC and 33.5% were at the some time totally dependent and affected by severe or non-assessable cognitive impairments. The patients had 2584 T-LHS, of which 1058 (40.9%) were T-ILHS. Their M-LHS was 15 days, and the M-ILHS was 5 days. In general, the greater the LHS, the greater is the ILHS (Spearman's rho + 0.68, P < 0.001). Using a multivariate analysis, only the absence of formal aids before hospitalisation is independently associated with delayed discharge (F = 4.39, P = 0.038). The majority of the delays (69%) resulted from the difficulty in finding beds in long-term hospital wards, but the longest M-ILHS (9 days) was found in patients waiting for the Geriatric Evaluation Unit. The profile of patients and the pattern of hospital utilisation suggest a need to reorient the health care system, and to develop appropriate resources for the academic functions of education, research and patient care.