title: Breaking down the barriers! Factors contributing to barrier days in a mature trauma center.
abstract: BACKGROUND
  As we enter the brave new world of the Patient Protection and Affordable Care Act of 2010, it is imperative that trauma centers provide not only excellent but also cost-effective trauma care. To that end, we sought to determine those factors that contribute significantly to barrier days (BDs), when a patient is medically cleared for discharge but unable to leave the hospital. We hypothesized that there would be significant demographic and payor factors associated with BDs.
  
  
  METHODS
  All trauma admissions to a Level II trauma center discharged alive from 2010 to 2012 were queried from the trauma registry. BDs were identified and recorded at daily sign-out. Patients with a hospital length of stay of 24 hours or less or transferred to another hospital were excluded. Univariate logistic regression was used to analyze which factors were significant (p ≤ 0.05) for BDs. Significant variables were then included in a multivariate logistic regression model.
  
  
  RESULTS
  A total of 3,056 patients were included in the study, 105 (3.44%) of whom had at least one BD. Multivariate analysis revealed that patients awaiting nursing home placement and rehabilitation placement were at 6.39 and 2.79 times higher odds of having significant barriers to discharge, respectively, compared with patients who were discharged home. The multivariate model also showed that Medicaid coverage, one or more comorbidities, Injury Severity Score of 9 or greater, and one or more ventilation days had a significant correlation with the incidence of BDs.
  
  
  CONCLUSIONS
  This study suggests that discharge destination is a significant factor associated with BDs. Understanding what type of patient is prone to develop barriers to discharge will allow case managers and social workers to intervene with discharge planning early in that patient's hospital course to secure placement and possibly reduce health care costs and improve functional outcome.
  
  
  METHODS
  Prognostic/epidemiologic study, level III.
authors.affiliation: From the Trauma Services, Lancaster General Health, Lancaster, Pennsylvania.
authors.forename: Amelia
authors.initials: A
authors.lastname: Rogers
authors.forename: Elizabeth Hoffer
authors.initials: EH
authors.lastname: Clark
authors.forename: Katelyn
authors.initials: K
authors.lastname: Rittenhouse
authors.forename: Michael
authors.initials: M
authors.lastname: Horst
authors.forename: Mathew
authors.initials: M
authors.lastname: Edavettal
authors.forename: John C
authors.initials: JC
authors.lastname: Lee
authors.forename: Daniel
authors.initials: D
authors.lastname: Wu
authors.forename: Tracy
authors.initials: T
authors.lastname: Evans
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Rogers
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009735:Nursing Homes; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D012047:Rehabilitation Centers; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013997:Time Factors; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States