title: Difficult hospital discharges in internal medicine wards.
abstract: OBJECTIVE
  Investigate the prevalence of difficult hospital discharges (DHD), describe clinical and social patients' characteristics as potential reasons for discharge delays in an internal medicine ward and implement tailored post-discharge care.
  
  
  METHODS
  During the year 2005 we analysed, in a middle-sized country hospital, all the patients for which some delay for discharge, owing to their whole complexity, was presumable. Comprehensive multidimensional assessment, clinical-social risk score, specific needs of care, mean of stay and outcomes were evaluated.
  
  
  RESULTS
  68.5% of DHD patients were >/=80 years old, with 3.8 the mean number of diseases per patient; 57.5% presented a loss of autonomy (ADL) just before acute deterioration; 80% were functionally and/or cognitively impaired. Only 5% had suitable family support; 5.1% were living at a nursing home; 2% were living alone. The most frequent causes of admission were stroke, cognitive impairment-dementia, cardiovascular diseases, fractures and cancer. Mean length of stay was 12 days. Fifty-two percent of patients were discharged home, 30% were admitted to a long-term care facility, 1% to hospice and 17% died during their hospital stay.
  
  
  CONCLUSIONS
  The aim of "coordinated care" (i.e., targeting "at-risk" patients with assessment of medical, functional, social and emotional needs; provision of optimal medical treatment, self-care education, integrated services, monitoring of progress and early signs of problems) is to improve health outcomes and reduce costs. More than 80% of DHDs patients, with specific tailored programmes, may be discharged from hospital, with satisfactory solutions for them and their families.
authors.affiliation: Internal Medicine Department, Bazzano Hospital, Azienda USL di Bologna, Bologna, Italy. r.nardi@auslbosud.emr.it
authors.forename: R
authors.initials: R
authors.lastname: Nardi
authors.forename: G
authors.initials: G
authors.lastname: Scanelli
authors.forename: A
authors.initials: A
authors.lastname: Tragnone
authors.forename: A
authors.initials: A
authors.lastname: Lolli
authors.forename: P
authors.initials: P
authors.lastname: Kalfus
authors.forename: A
authors.initials: A
authors.lastname: Baldini
authors.forename: T
authors.initials: T
authors.lastname: Ghedini
authors.forename: S
authors.initials: S
authors.lastname: Bombarda
authors.forename: L
authors.initials: L
authors.lastname: Fiadino
authors.forename: S
authors.initials: S
authors.lastname: Di Ciommo
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006757:Hospital Units / Q000706:statistics & numerical data*; D006766:Hospitals, County / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D015995:Prevalence