An examination of factors influencing delayed discharge of older people from hospital

Abstract

Objective: This study aimed to investigate the factors associated with the delayed discharge of older people from hospital and their length of stay (LOS).

Methods: Data were collected retrospectively from inpatient records and adult social care services on older patients referred to the latter prior to hospital discharge.

Results: Data on two related measures--delayed discharge and LOS--were analysed separately within a four-stage sequential framework. Using bivariate analysis, we found that cognitive impairment and dependency were significantly associated with delay. Patients admitted to trauma and orthopaedics specialties were significantly more likely to be delayed on discharge. Respiratory illness was negatively associated with delay. Factors related to care received as an inpatient associated with delayed discharge from hospital were not being in the responsible consultant's bed for part of their stay, two or more moves between specialties and receipt of rehabilitation services. Admission to a care home and receipt of domiciliary care if returning to a private dwelling on discharge were associated with delay. In the multivariate analysis, dependence and cognitive impairment impacted differently on delay and LOS. Hospital variables were the most important predictors of LOS and social care variables in respect of delayed discharge.

Conclusion: Patient characteristics and especially the organisation of care in hospital and the provision of services on discharge are related to the likelihood of delayed discharge and LOS. Improved services and structures to systematically assess and treat patient needs in hospital, together with the timely provision of services providing post-discharge services tailored to individual circumstances, are required.

Keywords: care pathway; cognitive impairment; dependence; hospital discharge; post-discharge care.