SHM Converge Scientific Abstract ePoster Gallery-Evaluation of Discharge Barriers for Patients With Avoidable Days at a Safety-Net Hospital

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This retrospective study examined discharge barriers for adult patients with prolonged hospital stays and “avoidable days” at a large safety-net hospital. The goal was to identify common reasons why discharge was delayed across the entire hospital, since few studies have looked at barriers institution-wide.<br /><br />Hospital care management staff reviewed avoidable-day cases weekly and documented discharge barriers in a database. The study included adults discharged between August 2019 and February 2020 who had at least one avoidable day and a total hospitalization of 21 days or more.<br /><br />A total of 180 cases were analyzed. Patients had a mean age of 57.7 years, and 70.6% were men. The most common service lines were medicine, surgery, neurosurgery, and orthopedics. Nearly half of patients were ultimately discharged to a skilled nursing facility, while others went home, to adult family homes, inpatient rehab, medical respite, or other settings.<br /><br />The median number of avoidable days was 17.5, and the median hospital length of stay was 42 days.<br /><br />The study identified 21 common discharge barriers, including guardianship/legal decision-making issues, funding, long-term care placement, substance use, methadone/Suboxone needs, smoking, patient or family refusal of facilities, homelessness, caregiving needs, care needs exceeding SNF capacity, cognitive deficits, mental health issues, medical equipment, bariatric care, IV antibiotics, restraints, and behavioral problems.<br /><br />The most frequent barriers were care needs too great for available facilities, homelessness, substance use, guardianship issues, caregiving needs, long-term care needs, and funding problems.<br /><br />Overall, the findings suggest that discharge delays are driven by recurring patterns across inpatient services. Understanding these common typologies may help hospitals design better discharge planning strategies and improve patient flow.

Asset Subtitle

Maralyssa Bann

Meta Tag

Author List Maralyssa Bann, Tony Truong

Category Research

Concept Avoidable Hospital Days

Concept Discharge Barrier

Concept Care Needs

Concept Length of Stay

Concept Homelessness

Distinguished Non-Finalist

Presenter Organization Harborview Medical Center-University of Washington

Presenting Author Maralyssa Bann

Track Transitions of Care

Keywords

discharge barriers

avoidable days

prolonged hospital stay

safety-net hospital

hospital discharge planning

skilled nursing facility

guardianship issues

homelessness

substance use

patient flow

Avoidable Hospital Days

Discharge Barrier

Care Needs

Length of Stay

Homelessness