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. 2014 Apr;48(2):314-21.
doi: 10.1590/s0034-8910.2014048004971.

Reasons for discharge delays in teaching hospitals

[Article in English, Portuguese]
Soraia Aparecida da Silva  1 , Reginaldo Aparecido Valácio  1 , Flávia Carvalho Botelho  2 , Carlos Faria Santos Amaral  2
Affiliations

Reasons for discharge delays in teaching hospitals

[Article in English, Portuguese]
Soraia Aparecida da Silva et al. Rev Saude Publica. 2014 Apr.

Abstract

Objective: To analyze the causes of delay in hospital discharge of patients admitted to internal medicine wards.

Methods: We reviewed 395 medical records of consecutive patients admitted to internal medicine wards of two public teaching hospitals: Hospital das Clínicas of the Universidade Federal de Minas Gerais and Hospital Odilon Behrens. The Appropriateness Evaluation Protocol was used to define the moment at which notes in the medical records indicated hospital stay was no longer appropriate and patients could be discharged. The interval between this estimated time and actual discharge was defined as the total number of days of delay in hospital discharge. An instrument was used to systematically categorize reasons for delay in hospital discharge and frequencies were analyzed.

Results: Delays in discharge occurred in 60.0% of 207 hospital admissions in the Hospital das Clínicas and in 58.0% of 188 hospital admissions in the Hospital Odilon Behrens. Mean delay per patient was 4.5 days in the former and 4.1 days in the latter, corresponding to 23.0% and 28.0% of occupancy rates in each hospital, respectively. The main reasons for delay in the two hospitals were, respectively, waiting for complementary tests (30.6% versus 34.7%) or for results of performed tests to be released (22.4% versus 11.9%) and medical-related accountability (36.2% versus 26.1%) which comprised delays in discussing the clinical case and in clinical decision making and difficulties in providing specialized consultation (20.4% versus 9.1%).

Conclusions: Both hospitals showed a high percentage of delay in hospital discharge. The delays were mainly related to processes that could be improved by interventions by care teams and managers. The impact on mean length of stay and hospital occupancy rates was significant and troubling in a scenario of relative shortage of beds and long waiting lists for hospital admission.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Reasons for hospital stay in internal medicine care wards in two public teaching hospitals. Minas Gerais, Southeastern Brazil, January to March 2010. HC: Hospital das Clínicas da Universidade Federal de Minas Gerais a Some patients met more than one criteria for hospitalization.
Figure 2
Figure 2
Delay factors in hospital discharge in internal medicine wards of two public teaching hospitals. Minas Gerais, Southeastern Brazil, January to March 2010. HOB: Hospital Odilon Behrens; HC: Hospital das Clínicas da Universidade Federal de Minas Gerais
Figure 3
Figure 3
Mean days of delay in hospital discharge in internal medicine wards of two public teaching hospitals, according to cause of delay. Minas Gerais, Southeastern Brazil, January to March 2010. HOB: Hospital Odilon Behrens; HC: Hospital das Clínicas da Universidade Federal de Minas Gerais
See this image and copyright information in PMC

References

    1. Agresti A. Categorical Data Analisys. New Jersey: John Wiley and Sons; 2002.
    1. Anderson P, Meara J, Brodhurst S, Attwood S, Timbrell M, Gatherer A. Use of hospital beds: a cohort study of admissions to a provincial teaching hospital. BMJ. 1998;297(6653):910–912. - PMC - PubMed
    1. Apolone G, Fellin G, Tampieri A, Bonanoni E, Crosti PF, Lanzi E, et al. Appropriateness of hospital use. Report from an Italian study. Eur J Public Health. 1997;7(1):34–39. doi: 10.1093/eurpub/7.1.34. - DOI
    1. Carey MR, Sheth H, Braithwaite S. A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service. J Gen Intern Med. 2005;20(2):108–115. doi: 10.1111/j.1525-1497.2005.40269.x. - DOI - PMC - PubMed
    1. Chopard P, Perneger TV, Gaspoz JM, Lovis C, Gousset D, Rouillard C, et al. Predictors of inappropriate hospital days in a department of internal medicine. Int J Epidemiol. 1998;27(3):513–519. - PubMed