Delayed discharges from Oxford city hospitals: who and why?
OBJECTIVE
To determine the extent and characteristics of discharge delays of younger patients from acute hospital beds in Oxford, England.


METHODS
Three-month prospective analysis of patients deemed to have delayed discharge.


METHODS
The primary measure was the number of days from the patient being no longer in need of acute medical inpatient care to eventual discharge. Additional assessments included demographic data, primary diagnosis, Motricity Index, Short Orientation-Memory-Concentration Test (SOMC), Barthel Index and contextual data.


METHODS
The major acute hospitals serving the county of Oxfordshire (560,000 people).


METHODS
Fifty patients aged 18-70 years identified by referrals, delayed discharge lists and ward visits whose discharge from hospital had been delayed.


RESULTS
The mean (standard deviation, SD) delay period was 36.1 (26.8) days. The mean prevalence and incidence of discharge delays for each three-day period was 19.7 (SD 1.7) and one (SD 1.7) respectively. Most (88%, n = 44) had a primary neurological diagnosis. Twenty-four (48%) patients had Motricity Index scores of less than 50% in one or more limbs and 16 (32%) in two or more limbs. Twenty-six (52%) patients had cognitive impairment (SOMC <18/28). Thirty-nine (78%) patients had a Barthel Index score of less than 15/20 and 24 (48%) of less than 10/20. The period of discharge delay did not correlate with SOMC, Motricity or Barthel Index scores. Only nine had appropriate accommodation available.


CONCLUSIONS
Patients whose discharge is delayed were common; most had a neurological disability and cognitive impairment; and accommodation was unsuitable or absent for most. Reorganizing services to give patients access to specialized disability services might both improve the care of these patients and increase the efficiency of the health service.
Carter
Nicholas D
ND
Rivermead Rehabilitation Centre, Oxford, UK.
Wade
Derick T
DT
D000293:Adolescent; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000534:rehabilitation; D004739:England; D017048:Health Care Costs; D006300:Health Services Misuse; D006301:Health Services Needs and Demand; D006786:Hospitals, Urban / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D012046:Rehabilitation / Q000458:organization & administration*