Homelessness and discharge delays from an urban safety net hospital

Abstract

Objectives: Homelessness is associated with increased morbidity and mortality, as well as increased rates of hospitalizations. Once hospitalized, homeless patients have longer hospital stays than housed persons, and hospital costs have been found to be increased for homeless patients. We sought to describe hospital discharge delays for nonmedical reasons and their relationship to the housing status of participants.

Study Design: Retrospective chart review of admissions and discharges between January 1 and June 30, 2009 at a large, urban safety net hospital.

Methods: All inpatients who experienced discharge delays for nonmedical or external causes were participants, and the main measures included length of and reasons for discharge delay.

Results: Persons identified as homeless constituted 106 (42.9%) of the discharge delays. Homeless patients were younger, more likely to be male, and more likely to be uninsured than housed patients. The unadjusted median number of delay days was significantly longer for homeless (8 days) than housed patients (4 days) (p<0.001). Multivariate analyses demonstrated that homeless patients without a psychiatric diagnosis had 60.1% longer discharge delays than housed patients without a psychiatric diagnosis (p=0.011).

Discussion: Among patients without psychiatric diagnoses who are medically ready for discharge, homeless patients experience more frequent and longer discharge delays than housed patients. Medical respite care has the potential to decrease unnecessary hospitalization days and improve access to after-hospital services that have proven to be beneficial for this population. Further prospective study of discharge delays may help to establish the cost-effectiveness of respite care.