SHM Converge Scientific Abstract ePoster Gallery-Discharge Barriers Associated With Long Length of Stay Hospitalizations

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UNC Hospitals reviewed prolonged hospitalizations over a one-year period (May 2023–May 2024) to identify discharge barriers in patients with long lengths of stay. The goal was to understand why some patients remained hospitalized after no longer needing acute care, especially those medically ready for discharge.<br /><br />A total of 1,239 unique patient encounters were manually reviewed on hospital day 20 or later. The team identified 26 distinct discharge barriers and tracked patients who were medically ready for discharge. Pediatric patients were excluded.<br /><br />The most common barrier was lack of mobility, affecting 56% of all patients and 72.9% of patients who were medically ready for discharge. For medically ready patients, the second most frequent barrier was lack of or delay in post-acute resources (56.1%). Other major barriers included complex surgical wound care (45.7%) and nutritional needs (32.9%).<br /><br />The findings highlight that functional mobility deficits are a major contributor to unnecessary hospital days and should be prioritized for intervention. The study also reinforces the importance of improving access to post-acute care resources, as well as better coordination of wound care and nutritional support.<br /><br />In response to these findings, the team developed an automated electronic medical record process to identify discharge barriers in real time. A dashboard will show both historical and daily barriers for patients with prolonged hospital stays. Future plans include expanding this tool across the health system and using natural language processing to improve detection and workflow support.

Asset Subtitle

Patrick M. O'Shea

Meta Tag

Author List Christopher A. Caulfield, Jaydeep Lamba, Leonardo Marucci, Patrick M. O'Shea, Robert W. Lampman

Category Innovations

Concept Prolonged Hospitalization

Concept Discharge Barrier

Concept Mobility Limitation

Concept Post-Acute Care Resource Delay

Concept Length of Stay

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Patrick M. O'Shea

Track Quality Improvement

Keywords

prolonged hospitalization

discharge barriers

length of stay

mobility impairment

post-acute resources

medically ready for discharge

wound care

nutritional support

electronic medical record

natural language processing

Prolonged Hospitalization

Discharge Barrier

Mobility Limitation

Post-Acute Care Resource Delay

Length of Stay