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Post-acute care discharge delays for neurology inpatients: Opportunity to improve patient flow.
Neurol Clin Pract 2018; 8(4):302-310NC

Abstract

Background

Hospital stays for patients discharged to post-acute care are longer and more costly than routine discharges. Issues disrupting patient flow from hospital to post-acute care facilities are an underrecognized strain on hospital resources. We sought to quantify the burden of medically unnecessary hospital days for inpatients with neurologic illness and planned discharge to post-acute care facilities.

Methods

We conducted a retrospective evaluation of hospital discharge delays for patients with neurologic disease and plans for discharge to post-acute care. We identified 100 sequential hospital admissions to an academic neurology inpatient service that were medically ready for discharge from December 4, 2017, to January 25, 2018. For each patient, we quantified the number of medically unnecessary hospital days, or all days in the hospital following the determination of medical discharge readiness.

Results

Among 100 patients medically ready for discharge with plans for post-acute care disposition (47 female, mean age 72.5 years, mean length of stay 12.3 days), 50 patients were planned for discharge to skilled nursing, 37 to acute rehabilitation, 10 to hospice/palliative care, and 3 to other facilities. There was a total of 1,226 patient-days, and 480 patient-days (39%) occurred following medical readiness for discharge. Medically unnecessary days ranged from 0 to 80 days per patient (mean 4.8, median 2.5, interquartile range 1-5 days).

Conclusion

Unnecessary hospital days represent a large burden for patients with neurologic illness requiring post-acute care on discharge. These discharge delays present an opportunity to improve hospital-wide patient flow.

Authors+Show Affiliations

Department of Neurology, University of Rochester Medical Center, NY.Department of Neurology, University of Rochester Medical Center, NY.Department of Neurology, University of Rochester Medical Center, NY.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30140581

Citation

Roberts, Debra E., et al. "Post-acute Care Discharge Delays for Neurology Inpatients: Opportunity to Improve Patient Flow." Neurology. Clinical Practice, vol. 8, no. 4, 2018, pp. 302-310.
Roberts DE, Holloway RG, George BP. Post-acute care discharge delays for neurology inpatients: Opportunity to improve patient flow. Neurol Clin Pract. 2018;8(4):302-310.
Roberts, D. E., Holloway, R. G., & George, B. P. (2018). Post-acute care discharge delays for neurology inpatients: Opportunity to improve patient flow. Neurology. Clinical Practice, 8(4), pp. 302-310. doi:10.1212/CPJ.0000000000000492.
Roberts DE, Holloway RG, George BP. Post-acute Care Discharge Delays for Neurology Inpatients: Opportunity to Improve Patient Flow. Neurol Clin Pract. 2018;8(4):302-310. PubMed PMID: 30140581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-acute care discharge delays for neurology inpatients: Opportunity to improve patient flow. AU - Roberts,Debra E, AU - Holloway,Robert G, AU - George,Benjamin P, PY - 2018/03/18/received PY - 2018/05/30/accepted PY - 2018/8/25/entrez PY - 2018/8/25/pubmed PY - 2018/8/25/medline SP - 302 EP - 310 JF - Neurology. Clinical practice JO - Neurol Clin Pract VL - 8 IS - 4 N2 - Background: Hospital stays for patients discharged to post-acute care are longer and more costly than routine discharges. Issues disrupting patient flow from hospital to post-acute care facilities are an underrecognized strain on hospital resources. We sought to quantify the burden of medically unnecessary hospital days for inpatients with neurologic illness and planned discharge to post-acute care facilities. Methods: We conducted a retrospective evaluation of hospital discharge delays for patients with neurologic disease and plans for discharge to post-acute care. We identified 100 sequential hospital admissions to an academic neurology inpatient service that were medically ready for discharge from December 4, 2017, to January 25, 2018. For each patient, we quantified the number of medically unnecessary hospital days, or all days in the hospital following the determination of medical discharge readiness. Results: Among 100 patients medically ready for discharge with plans for post-acute care disposition (47 female, mean age 72.5 years, mean length of stay 12.3 days), 50 patients were planned for discharge to skilled nursing, 37 to acute rehabilitation, 10 to hospice/palliative care, and 3 to other facilities. There was a total of 1,226 patient-days, and 480 patient-days (39%) occurred following medical readiness for discharge. Medically unnecessary days ranged from 0 to 80 days per patient (mean 4.8, median 2.5, interquartile range 1-5 days). Conclusion: Unnecessary hospital days represent a large burden for patients with neurologic illness requiring post-acute care on discharge. These discharge delays present an opportunity to improve hospital-wide patient flow. SN - 2163-0402 UR - https://www.unboundmedicine.com/medline/citation/30140581/Post_acute_care_discharge_delays_for_neurology_inpatients:_Opportunity_to_improve_patient_flow_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=30140581.ui DB - PRIME DP - Unbound Medicine ER -