Reasons for delayed discharge of trauma patients.
BACKGROUND
In the trauma population, increased length of stay is associated with age, comorbidities, and injury severity. We hypothesized that a significant contributor to a delay in length of stay was unrelated to these variables.


METHODS
All trauma patients admitted for > 48 h with acute injury from 7/1/2000 to 9/30/2000 were evaluated daily for discharge readiness. Actual discharge time was recorded from the time discharge orders were written. A discharge-ready patient not discharged within 24 h was a Delay discharge. Discharge delay was categorized as availability of rehabilitation beds, family reasons, or system-related delay. Payer was classified as commercial, government, Medicare, or uninsured. Actual hospital costs were used.


RESULTS
One hundred twenty-eight patients were evaluated; 30 patients had a delay in discharge. The average delay was 2 days (range 1-15 days). Mean hospital stay for Delay patients was 13.4 days, and 8.1 days for Timely patients (P < 0.05). Injury severity, age, and comorbidities were not different among groups. The main reason for delay was lack of a rehabilitation bed. Hospital costs were $39,013 per patient in the Delay group and $24,414 in the Timely group. Delay patients were more likely to be uninsured, have an orthopedic injury, and require ICU care.


CONCLUSIONS
Discharge delays significantly lengthen hospital stay for nonmedical reasons in trauma patients. Improved efficiency in a trauma system will require changes from acute care to rehabilitation.
Brasel
Karen J
KJ
Department of Surgery, Medical College of Wisconsin, Milwaukee 53226, USA. kbrasel@mcw.edu
Rasmussen
Jason
J
Cauley
Charline
C
Weigelt
John A
JA
D000328:Adult; D003365:Costs and Cost Analysis; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007348:Insurance, Health; D007362:Intensive Care Units; D007902:Length of Stay; D010351:Patient Discharge; D014947:Wounds and Injuries