Delays in discharge in a tertiary care pediatric hospital.
BACKGROUND
Delays in discharges affect both efficiency and timeliness of care; 2 measures of quality of inpatient care.


OBJECTIVE
Describe number, length, and type of delays in hospital discharges. Characterize impact of delays on overall length of stay (LOS) and costs.


METHODS
Prospective observational cohort study.


METHODS
Tertiary-care children's hospital.


METHODS
All children on 2 medical teams during August 2004.


METHODS
Two research assistants presented detailed data of patient care (from daily rounds) to 2 physicians who identified delays and classified the delay type. Discharge was identified as delayed if there was no medical reason for the patient to be in the hospital on a given day.


METHODS
Delays were classified using a validated and reliable instrument, the Delay Tool. LOS and costs were extracted from an administrative database.


RESULTS
Two teams cared for 171 patients. Mean LOS and costs were 7.3 days (standard deviation [SD] 14.3) and $15,197 (SD 38,395), respectively: 22.8% of patients experienced at least 1 delay, accounting for 82 delay-related hospital days (9% of total hospital days) and $170,000 in costs (8.9% of hospital costs); 42.3% of the delays resulted from physician behavior, 21.8% were related to discharge planning, 14.1% were related to consultation, and 12.8% were related to test scheduling.


CONCLUSIONS
Almost one-fourth of patients in this 1-month period could have been discharged sooner than they were. Impact of delays on LOS and costs are substantial. Interventions will need to address variations in physician criteria for discharge, more efficient discharge planning, and timely scheduling of consultation and diagnostic testing.
Srivastava
Rajendu
R
Division of Inpatient Medicine, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah 84113, USA. raj.srivastava@hsc.utah.edu
Stone
Bryan L
BL
Patel
Raza
R
Swenson
Matthew
M
Davies
Andrew
A
Maloney
Christopher G
CG
Young
Paul C
PC
James
Brent C
BC
D002675:Child, Preschool; D015331:Cohort Studies; D006776:Hospitals, Pediatric / Q000191:economics* / Q000639:trends; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics / Q000639:trends; D010351:Patient Discharge / Q000191:economics* / Q000639:trends; D011446:Prospective Studies; D055512:Tertiary Prevention / Q000191:economics* / Q000639:trends; D013997:Time Factors